Presented  in  honor  of 

lliam  R.  Laughlin,  D.  0. 

by 
'lliamR.  Laughlin 


COLLEGE    OF    OSTEOPATHIC    PHYSICIANS 
AND  SURGEONS  •    LOS  ANGELES,  CALIFORNIA 


WILLIAM   ROSS  LAUGHLIN 

M.S.  -  D.O. 
Los  ANGELES.  CALIFORNIA 


The  ^Praftice  and  Applied 
Therapeutics  of 

OSTEOPATHY 


By 
HAZ 


CHARLES  HAZZARD,  Ph.  B.,  D.  O. 

Author  of  "Principles  of  Osteopathy,"  Former  Profes- 
sor of  the  Principles  of  Osteopathy  and  of  the 
Practice  of^Osteopathy,  Superintendent  of 
Clinics,  American  School  of  Oste- 
opathy, Kirksville,  Missouri. 


(Third  Revised  Edition.) 


KIRKSVILLE 

JOURNAL   PRINTING   CO. 
1905. 


\A>JJ    7V  V 


Copyright 

by 

CHARLES  HAZZARD 
1905. 


PRACTICE    OF    OSTEOPATHY. 


Preface  to  the  Third  Edition. 


Since  the  publication  of  the  second  edition  of  this  work,  the 
growth  and  progress  of  Osteopathy  have  been  marked,  and  it 
has  been  the  aim  of  the  author  to  have  these  pages  reflect  those 
virile  characteristics  of  the  Science.  He  has  made  an  earnest 
endeavor  to  add  to  his  previous  work  as  much  as  possible  that 
would  be  of  value  to  the  profession.  The  work  has  been  rewritten 
in  many  parts,  and  much  new  matter  has  been  added  throughout, 
considerably  enlarging  the  volume. 

The  same  considerations  that  before  led  to  the  omission  from 
these  pages  of  the  facts  of  pathology,  symptomatology,  etc., 
which  the  student  finds  useful  in  his  studies,  but  which  are  so 
available  from  other  sources,  were  still  deemed  sufficient.  But 
the  continued  demand  for  a  compact  work  upon  this  subject,  of 
moderate  price,  and  devoted  exclusively  to  osteopathic  considera- 
tions seems  to  warrant  the  bringing  out  of  this  further  edition. 

CHARLES  HAZZARD, 

New  York  City,  Nov  18,  1905 

"Go  little  book, 

"Bearing  an  honored  name, 
"  'Till  everywhere  that  you  have  went, 

"They're  glad  that  you  have  came." 

—(BILL  NYE  OR  SHAKESPEARE.) 


PRACTICE    OF    OSTEOPATHY. 


Preface  to  the  Second  Edition. 


In  preparing  the  second  edition  for  press,  much  care  has 
been  taken  to  make  the  work  a  complete  text-book  upon  the 
subject  of  Practice  of  Osteopathy,  and  to  make  it  thoroughly 
osteopathic  throughout. 

It  is  obviously  unnecessary  to  include-  in  such  a  work  ma- 
terial so  easily  available  in  the  many  standard  texts  of  medical 
practice.  It  is  better  that  the  student  should,  so  far  as  neces- 
sary, refer  to  them  for  the  symptomatology,  pathology,  etc.,  of 
the  diseases  he  studies,  rather  than  to  fill  these  pages  with  a  repeti- 
tion of  what  has  been  so  well  written  elsewhere.  Thus  the  author 
is  left  free  to  devote  these  pages  exclusively  to  the  osteopathic 
aspects  of  disease.  Collaterally  with  this  work  one  may  use  any 
standard  medical  practice,  as  was  done  in  the  American  School 
in  the  course  in  which  the  matter  presented  in  this  volume  was 
delivered  as  a  course  of  lectures. 

The  second  edition  is  thoroughly  revised  and  much  en- 
larged. To  Part  I  have  been  added  various  points  of  use  in 
examination  and  diagnosis  from  an  osteopathic  point  of  view. 
To  Part  II  have  been  added  several  hundred  new  case  reports. 
These  reports  have  been  added  to  the  subjects  which  were  con- 
sidered in  the  first  edition,  and  have  likewise  been  added  to  the 
work  in  the  consideration  of  the  many  diseases  not  discussed  in 
the  first  edition. 

By  the  use  of  these  many  CASE  REPORTS  there  is  established 
a  foundation  of  actual  fact  and  experience  for  this  work.  Theory 
is  of  value,  and  is  assigned  its  proper  place  here,  but  the  facts 
shown  in  the  case-reports  have  been  demonstrated  by  the  actual 
work  of  Osteopaths  in  all  parts  of  the  field,  whence  these  reports 
are  drawn.  They  give  to  the  practitioner  the  value  of  others' 
experience.  Much  care  has  been  given  to  the  analysis  of  LESIONS 
presented  by  reports,  and  to  the  pointing  out  of  the  lesions  which 
may  be  expected  as  the  CAUSES  of  disease. 


6  PRACTICE    OF    OSTEOPATHY. 

Under  the  head  of  ANATOMICAL  RELATIONS  are  considered 
the  anatomical  and  physiological  reasons  why  various  given 
lesions  may  derange  function  and  cause  disease.  These  points 
have  involved  much  careful  research,  and  the  author  feels  that 
they  will  be  found  of  value  to  student  and  practitioner  alike. 

The  TREATMENT  of  each  disease  is  discussed  at  some  length. 
Much  thought  must  be  devoted  by  the  successful  practitioner 
to  his  method  of  handling  his  case.  In  each  case  the  various 
points  of  treatment  applicable  are  pointed  out.  Part  I  is  re- 
ferred to  in  these  sections  as  a  key  to  Part  II.  In  this  way  specific 
treatments  are  indicated. 

CHARLES  HAZZARD. 

Kirksville,  Mo.,  June  1,  1901. 


PRACTICE   OF   OSTEOPATHY. 


PART  I— GENERAL  METHODS. 

CHAPTER  I. 

EXAMINATION  OF  THE  SPINE. 

Inspection,  percussion  and  palpation  are  the  physical  meth- 
ods employed  by  the  examiner.  Of  these  the  latter  is  most 
important.  Attention  must  be  given  to  the  position  of  the  pa- 
tient, changing  it  as  required  for  the  best  detection  of  the  various 
lesions  for  which  examination  is  being  made.  For  example, 
lateral  deviations  of  vertebrae  and  departures  from  normal  cur- 
vature of  the  spine  are  best  detected  while  the  patient  is  sitting. 
Points  of  separation  between  spinous  processes,  thickening  of 
posterior  spinal  ligaments,  rigidity  of  the  spine,  etc.,  are  most 
readily  made  out  while  the  patient  is  lying  upon  the  side. 

The  back  must  be  bared  in  examination.  For  ladies,  a 
loose  gown  buttoned  down  the  front  and  back  may  be  convenient- 
ly used. 

By  the  methods  mentioned  above  the  examiner  searches 
for  certain  definite  legions,  as  follows: 

INSPECTION  reveals  the  color  of  the  skin;  rashes,  which  may 
indicate  disease;  the  presence  of  curvature  or  other  deformity; 
unequal  muscular  development,  or  change  of  contour  from  what- 
ever cause;  scars,  wounds,  stains,  and  excoriations,  leading  to 
inquiry  regarding  accident,  injury,  operation,  or  the  use  of  poul- 
tice; injected  blood-vessels;  tumors,  enlargement  of  parts,  etc. 

Inspection  may  be  made  with  the  patient  sitting. 

In  any  examination,  care  must  be  taken  not  to  so  place  the 
patient  as  to  cause  his  position  to  mask  the  lesion.  An  un- 
natural posture  may  be  to  him  natural  by  reason  of  his  condit- 
ion. If  now  an  attempt  be  made  to  cause  him  to  assume  the 
usually  natural  position,  the  result  may  be  to  obscure  that  which 
would  be  a  clew  to  his  disability. 

Close  inspection  should  be  made  of  a  patient's  habitual 
posture,  gait,  etc.,  as  a  preliminary  step.  One  often  gains  thus 
valuable  clews  to  his  condition. 


8  PRACTICE    OF    OSTEOPATHY. 

Inspection  often  reveals  inequalities  of  waist-lines  and  hips. 
A  waist-line  deeper  cut  on  one  side,  usually  accompanied  by  a 
higher  or  larger  contour  of  the  corresponding  hip,  is  a  frequent 
indication  of  a  swerved  spine. 

PALPATION  is  our  most  important  method  of  examination, 
the  trained  touch  revealing  to  the  Osteopath  most  of  the  lesions 
which  he  regards  as  the  causes  of  disease.  . 

With  the  patient  sitting  slightly  bent  forward,  the  arms 
folded  loosely  or  the  hands  resting  lightly  on  the  knees,  the  ex- 
aminer stands  behind  the  patient  and  passes  his  two  index  fingers, 
or  the  index  and  second  fingers  of  the  examining  hand,  care- 
fully down  the  opposite  sides  of  the  vertebral  spines.  He  notes: 

I.  Single  vertebra  or  groups   of  vertebrae  which   may  be 
deviated  laterally  from  normal  position.     In  such  case  there  is 
usually,  though  not  always,  tenderness  in  the  tissues  upon  the 
side  of  deviation,  owing  to  the  irritation  by  the  process. 

In  order  not  to  mistake  a  bent  spinous  process  for  a  lateral 
lesion  of  the  vertebra,  all  such  apparent  lesions  should  be  further 
tested  by  feeling  out  the  transverse  processes  of  the  vertebra  in 
question.  Dr.  Still  uses  these  more  than  the  spinous  processes 
in  identifying  lateral  lesions.  If  the  spinous  process  is  merely 
bent  the  transverse  processes  have  not  changed  their  relations 
to  the  surrounding  tissues. 

Lateral  deviation  of  one  or  more  vertebrae  causes  the  trans- 
verse processes  to  rotate  slightly  backward  on  one  side  and  for- 
ward on  the  other.  This  alters  the  depth  of  the  furrow  running 
along  the  spine  on  either  side  of  the  spinous  processes.  Pressure 
of  the  examining  finger  carefully  into  those  furrows  at  the  point 
of  lesion  will  show  that  the  furrow  on  one  side  is  deeper,  and  on 
the  other  side  shallower,  than  normal. 

Such  observation  of  transverse  processes  and  furrows  will 
obviate  error  over  bent  spinous  processes. 

II.  Lateral  swerving  or  sagging  of  any  portion  of  the  spine. 

III.  Any  exaggeration,  deviation  from,  or  lessening  of  the 
normal  curves  of  the  spine.     The  most  common  of  these  are  a 
flattening  of  the  spine  anteriorly  at  the  dorsal  curve  between 
the  shoulders,  and  a  flattening  of  the  spine  posteriorly  at  the 


PRACTICE    OF    OSTEOPATHY.  9 

lumbar  curve,  these  two  lesions  together  causing  the  so-called 
" straight  spine." 

IV:  Sharp  friction,  made  by  passing  the  hand  quickly  down 
the  spine,  reddens  the  tips  of  the  spinous  processes  so  that  one 
may  then  count  them  or  note  their  alignment. 

V.  The  flat  of  the  hand  is  passed  down  over  the  posterior 
.aspect  of  the  sacrum  and  detects  any  flattening  or  bulging  thereof. 
It  is  also  passed  over  the  posterior  superior  iliac  spines,  noting 
their  degree  of  prominence  and  comparing  them  with  each  other 
relatively  to  the  sacrum. 

VI.  The  cushions  of  the  examining  fingers  are  pressed  deeply 
into  the  sacro-iliac  spaces  to  detect  any  abnormal  tension  or 
tenderness  in  the  superficial  or  deep  tissues. 

VII.  The  index  finger  follows  the  course  of  the  coccyx  to 
its  tip,  noting  any  lateral,  anterior,  or  posterior  deviation. 

VIII.  The  index  finger  is  carefully  passed  down  the  spine 
upon  the  spinous  processes,  pressure  being  made  firmly  upon  each, 
to  detect    either  anterior  or  posterior  projection  of  vertebrae. 

IX.  The  temperature  of  the  back  is  found  by  passing  the 
palm   of   the   hand   evenly   over   it.     Vaso-motor  disturbances, 
resulting  in  lowered  or  increased  temperature  of  certain  areas, 
may  be  thus  discovered.     Frequently  a  cold  area  may  be  traced 
diagonally  backward  and  upward  along  the  course  of  the  spinal 
nerves  toward  the  seat  of  lesion. 

The  patient  is  now  placed  upon  his  side  in  an  easy  posit- 
ion. The  examiner  stands  at  the  front  of  the  patient  and  con- 
tinues the  examination. 

X.  The  cushion  of  the  examining  finger,  which  is  held  at 
right  angles  to  the  spinal  column,  is  carefully  pressed  deeply 
into  the  space  between  each  successive  pair  of  spinous  processes. 
It  discovers  any  separation  or  approximation  of  processes,  thus 
of  vertebrae. 

Students  often  have  difficulty  in  distinguishing  a  separa- 
tion of  processes  from  an  anterior  displacement,  the  former  be- 
ing often  diagnosed  as  the  latter  condition.  One  may  avoid 
such  errors  by  remembering  that  the  separation  is  rarely  so  great 
as  the  space  left  by  a  marked  anterior  displacement  of  a  ver- 
tebrae. The  latter  condition  is  rare.  In  case  of  doubt  count 


10  PRACTICE    OF    OSTEOPATHY. 

the  next  two  spinous  processes  above  or  below  the  point  in  quest- 
ion, and  compare  the  space  they  occupy  with  the  space  occupied 
by  the  lesion  and  the  spinous  process  next  above  or  below  it. 
The  comparison  will  at  once  aid  in  determining  the  point. 

Points  of  anatomical  weakness  are  frequently  found  at 
the  junction  of  the  twelfth  dorsal  with  the  first  lumbar  verte- 
bra, also  at  the  junction  of  the  fifth  lumbar  with  the  sacrum. 

The  fifth  lumbar  is  often  prominent  posteriorly,  but  is  also- 
very  apt  to  be  luxated  anteriorly  or  laterally. 

Separations  occurring  between  the  fifth  and  the  sacrum 
are  often  mistakenly  treated  as  anterior  displacements  of  the 
fifth.  Separations  at  this  point  are  common.  Marked  tender- 
ness is  usually  present. 

XI.  The  examining  hand  is  passed  slowly  along  the  spinaL 
column  to  note  any  general  or  local  thickening  and  increased 
tension  in  the  posterior  spinal  ligaments  which  results  in  par- 
tially   obliterating    the   spaces    between   the    spinous   processes, 
and  in  producing  the  so-called  "smooth  spinal  column." 

XII.  The    examining    fingers    are   pressed    firmly   into    the 
spinal  muscles  and  moved  transversely  to  the  course  of  their 
fibres  for  the  purpose  of  detecting  any  abnormal  hardening  or 
contracturlng    of    them.     Contractures   generally    affect    certain 
sets  of  fibres  rather  than  the  muscle  as  a  whole.     They  may 
be  situated  in  the  superficial  or  in  the  deep  muscles,  and  may 
be  primary  or  secondary  according  as  they  are  produced  by  di- 
rect or  indirect  lesion  of  the  fibres. 

XIII.  The  body  of  the  patient  is  braced  against  that  of  the 
practitioner,  who  places  the  fingers  of  both  hands  upon  the  under 
side  of  the  row  of  spinous  processes,  (the  patient  lying  on  his 
side)  and  draws  the  spine  forcibly  toward  him,  noticing  whether 
the  spine  be  rigid,  or  too  greatly  relaxed. 

It  must  be  borne  in  mind  that  bony  lesions  are  not  alone 
important.  Ligamentous  lesions  are  quite  as  much  so,  and 
though  they  are  not  so  generally  discernible  as  are  the  former, 
the  student  must  not  forget  that  following  upon  and  conse- 
quent to  bony  lesion  they  may  bring  pressure  upon  important 
structures,  may  thus  interfere  with  the  functions  of  blood-vessels,, 
nerves,  etc.,  and  become  a  fruitful  source  of  ill. 


PRACTICE    OF    OSTEOPATHY.  11. 

PERCUSSION,  PRESSURE  AND  MOTION  may  be  employed  in 
the  examination  of  the  spine,  and  may  sometimes  reveal  deep 
tenderness  or  pain  in  the  tissues  which  has  escaped  notice  by 
the  other  methods. 

Upon  motion,  certain  sounds  are  heard  in  various  parts  of 
the  column,  due  to  the  motion  of  parts  upon  each  other. 

These  seem  to  occur  most  frequently  in  the  neck,  between 
the  articular  processes,  and  in  the  lumbar  region,  between  the 
bodies  of  the  vertebrae,  and  between  the  articular  processes. 
Motion  between  the  heads  of  the  ribs  and  the  bodies  of  the  ver- 
tebra?,  and  between  the  tubercles  of  the  ribs  and  the  transverse 
processes  is  frequent. 

They  may  occur  anywhere  along  the  spine  and  are  of  diag- 
nostic value  in  indicating  relaxation  of  ligaments,  interference 
with  blood-supply,  resulting  in  insufficient  secretion  of  synovial 
fluid,  or  malposition  of  bony  parts. 

A  motion  which  tends  to  separate  the  members  of  a  joint 
may  produce  a  suction  sound  therein.  A  sharp,  cracking  or 
snapping  sound  may  accompany  the  normal  play  of  tendons. 

The  "examiner  should  not  overlook  the  results  of  lesions 
which  in  any  way  alter  the  equilibrium  of  the  spinal  column. 
When  this  occurs,  the  weight  of  the  trunk  no  longer  rests  squarely 
upon  the  pelvis,  but  drives  upon  it  at  an  angle,  unequally  con- 
tracting lumbar  muscles  and  ligaments,  tilting  the  pelvis,  shorten- 
ing a  limb,  etc.  Lumbago  and  sciatica  often  result  from  such 
conditions,  as  do,  likewise,  various  neck  lesions,  and  even  spinal 
curvatures. 

CHAPTER  II. 
TREATMENT  OF  THE  SPINE. 

In  this  chapter  it  is  proposed  to  outline  the  general  method 
of  procedure  in  spinal  treatment.  As  no  specific  case  or  dis- 
ease is  now  under  consideration,  the  student  must  bear  in  mind 
that  the  treatments  described  are  general  methods  and  that  in 
any  given  case  he  would  find  it  necessary  to  select  and  combine 
these  different  modes  in  a  manner  best  calculated  to  enable  him 
individuallv  to  reach  the  case. 


12  PRACTICE    OF    OSTEOPATHY. 

As  far  as  practicable  the  specific  lesions  mentioned  in  Chapter 
I  will  be  considered,  and  treatments  appropriate  to  their  re- 
duction will  be  given. 

These  treatments  are  all  manipulative.  They  have  as 
their  object  the  righting  of  what  is  mechanically  wrong.  They 
are  therefore  mechanical  of  necessity,  and  are  founded  upon  the 
necessities  of  the  human  mechanism  when  deranged. 

In  treatment,  the  practitioner  may  have  in  view  either  or 
both  of  two  objects.  He  works  to  right  the  spine  itself,  and  to 
affect  it  alone,  or  he  works  upon  the  spine  to  affect  some  other 
part  of  the  body  pathologically  connected  with  the  part  of  the 
spine  in  question. 

I.  The  patient  lies  upon  the  ventral  aspect  of  the  body  in 
as  comfortable  a  position  as  possible.     The  head  turns  easily 
to  one  side,  and  the  arms  hang  down  loosely  at  the  sides  of  the 
table.     The  practitioner  must  see  that  the  patient  thoroughly 
relaxes  the  muscles  of  the  whole  body.     He  now,  standing  at 
the  side  of  the  patient,  uses  the  palms  of  the  hands  or  the  cushions 
of  the  fingers  to  thorqughly  manipulate  and  relax  all  the  spinal 
muscles.     In  treating  the  muscles  upon  the  side  toward  him, 
he  works  from  one  end  of  the  spinal  column  to  the  other,  in  a 
direction  at  right  angles  to  the  general  direction  of  the  muscular 
fibres.     He  treats  the  muscles  of  the  opposite  side  by  spreading 
them  away  from  the  spinous  processes. 

In  this  way  all  contractures  of  the  muscles  are  released, 
flabby  muscles  are  toned,  blood  and  nerve  mechanisms  are  freed 
and  upbuilt.  This  removing '  of  contractures  is  sometimes  a 
necessary  preliminary  step  to  the  diagnosis  of  deeper  lesions 
which  may  have  been  masked  by  them. 

II.  The  patient  lies  upon  his  side,  the  practitioner  stands 
at  the  side  of  the  table,  in  front  of  the  patient;  with  one  hand 
he  grasps  the  uppermost  arm  of  the  patient  just  above  the  elbow; 
with  the  other  hand  he  holds  under  the  spinous  processes  of  any 
portion  of  the  spine  under  treatment.     Now,   using  the  arm  as 
a  lever,  he  pushes  it  downward  and  forward,  at  the  same  time 
springing  the  spine  toward  him. 

This  treatment  releases  tension  in  all  deep  structures,  re- 
stores free-play  between  bony  parts,  and  removes  pressure  from 


PRACTICE    OF   OSTEOPATHY.  13 

blood-vessels  and  nerves.  It  may  be  applied  in  all  cases  of 
curvature,  sagging  or  swerving  of  a  portion  of  the  spine,  lateral 
deviations  of  vertebra?,  in  separating  or  approximating  verte- 
brae, etc. 

III.  Practically  the  same  effect  may  be  obtained  upon  the 
lower  portion  of  the  spine  as  follows:  with  the  patient  still  upon 
the  side,  his  thighs  and  legs  are  flexed,  and  fixed  by  pressure  of 
the  abdomen  of  the  practitioner  against  them.     Both  hands  are 
now  free  and  spring  the  spine  strongly  upward  toward  him,  or 
to  manipulate  the  muscles;  or, 

IV.  With  the  patient  still  lying  upon  his  side,  the  practi- 
tioner leans  over  him,  placing  his  forearms,  one  against  the  iliac 
crest  and  the   other  against  the  shoulder.     He  now  with  his 
forearms  pushes  these  two  points  further  apart,  while  with  both 
hands  he  springs  the  middle  portions  of  the  spine  toward  him, 
or  manipulates  the  muscles. 

It  will  be  observed  that  the  treatment  described  under  II, 
III  and  IV  above  all  may  be  used  to  thoroughly  stretch  any 
portion  of  the  spine  by  laterally  directed  force.  In  this  way 
deeper  stretching  of  all  spinal  structures  may  be  accomplished 
within  the  limits  of  safety  than  by  stretching  the  spine  as  a  whole 
by  longitudinal  traction. 

V.  The  latter  is  applied  with  the  patient  lying  upon  his 
back;  the  practitioner,  standing  at  the  head  of  the  table,  passes 
one  hand  beneath  the  occiput,  the  other  beneath  the  chin,  and 
draws  toward  him.     The  required  degree  of  resistance  is  afforded 
by  the  weight  of  the  patient  or  by  an  assistant  holding  the  ankles. 

The  neck  must  not  be  rotated  during  this  forcible  tension, 
and  jerking  must  be  avoided. 

VI.  The  principle  of  exaggeration  of  the  lesion  is  one  that 
may  be  applied  to  the  treatment  of  many  bony  luxations.     It 
consists  in  so  manipulating  the  parts  as  to  tend  to  further  in- 
crease their  malposition,  and  in  then  applying  pressure  to  them 
in  such  a  direction  as  to  force  them  back  toward  normal  position 
at  the  same  time  as  the  part  in  question  is  released  from  its  con- 
dition of  exaggeration. 

This  motion  releases  tension,  loosens  adhesions,  and  gains 


14  PRACTICE    OF   OSTEOPATHY. 

the  benefit  of  the  natural  recoil  of  the  structures  from  their  ex- 
aggerated  position. 

VII.  With  the  patient  prone  and  the  practitioner  kneeling 
upon  the  table  at  one  side  of  the  patient,  or  with  a  knee  upon 
either  side,  direct  pressure  may  be  applied,  from  above  down- 
ward, to  all  spinal  parts.     This  position  of   relaxtion  is   favor- 
able for  forcing  vertebrae  or  the  heads  of  ribs  into  place  and  for 
the  stretching  of  the  deep  and  anterior  spinal  ligaments. 

VIII.  The  patient  lies  across  the  table  with  the  abdomen 
and  anterior  chest  resting  upon  it,  the  arms  and  head  hanging 
loosely  down  upon  one  side  and  the  legs  upon  the  other.     The 
practitioner  may  stand  at  either  side  of  the  table  (or  kneel  upon 
it,)  and  work  for  results  as  in  VII,  with  the  additional  advantage 
that  the  arms,  neck,  or  limbs  may  be  manipulated  at  will  in  the 
course  of  the  treatment. 

IX.  The  patient  sits,  the  practitioner  stands  in  front,  slightly 
to  one  side  facing  backward  from  the  patient.     He  passes  the 
arm  nearest  the  patient  back  of  the  neck,  and  slips  his  hand 
under  the  opposite  axilla  from  in  front.     This  bends  the  neck 
and  upper  spine  forward  and  swings  the  opposite  side  of  the 
thorax  backward,  thus  rotating  the  spine.     By  using  the  free 
hand  as  a  fixed  point  at  various  points  along  the  spine,  its  suc- 
cessive portions  may  be  thoroughly  rotated  and  all  of  its  struc- 
tures loosened. 

X.  The  patient  sits;  the  practitioner  stands  behind,  push- 
ing the  head  forward  and  to  one  side  with  one  hand,  while  with 
the  other  he  makes  fixed  points  along  the  upper  spine,    upon  the 
side  from  which  the  head  has  been  forced.     The  head  is  now 
swung  forward  and  to  the  side  opposite  its  first  position  while 
the  hand  brings  pressure  upon  the  fixed  points,  one  after  the 
other.     This  motion  makes  use  of  the  neck  as  a  lever  of  the  first 
class,  the  fulcrum  being  formed  by  the  hand  at  the  fixed  point, 
with  the  lesion  (weight)  below,  and  the  power  (hand  applied  to 
the  head)  above.     It  is  a  method  of  "exaggeration  of  the  lesion," 
and  is  especially  useful  for  the  reduction  of  lateral  luxations  in 
the  upper  part  of  the  spine. 

X.  (a)  A  variation  from  the  above  applies  the  same  prin- 
ciples to  lesions  lower  down  in  the  spine.     The  patient  sits;  the 


PRACTICE    OF    OSTEOPATHY.  15 

practitioner  stands  at  one  side  and  passes  one  arm  in  front  of 
him,  grasping  his  body  securely,  and  rotating  his  trunk  about 
fixed  points  made  at  any  desired  place  along  the  spine  by  the 
application  of  the  free  hand  to  it.  The  cushion  of  the  thumb 
of  this  hand  is  pressed  firmly  against  one  side  of  the  spines  of  the 
vertebrae  suffering  from  lesion,  while  the  bent  index  finger  is 
pressed  against  the  other. 

XI.  The  patient  sits  and  clasps  his  hands  behind  his  neck; 
the  practitioner  stands  close  behind,  passes  his  arms  beneath  the 
axillae  and  his  palms  behind  the  patient's  wrists,  which  he' grasps 
in   his   hands.     As   the   practitioner   straightens   his   body   and 
draws  the  patient  back  against  his  abdomen  the  neck  and  upper 
dorsal  spine  are  bent  forward,  the  scapulae  travel  back  and  up, 
and  all  of  the  ribs,  except  the  first  three  or  four  pairs,  which  are 
sprung  forward  and  downward,   are  drawn  strongly  backward 
and  upward. 

This  treatment  thoroughly  stretches  most  of  the  spinal 
ligaments,  costo-spinal  ligaments,  muscles  of  the  back  of  the 
neck,  scapula?,  and  of  the  spine.  It  also  brings  tension  upon 
most  of  the  intervertebral,  the  costo-vertebral,  the  costo-sternal, 
acromio-clavicular  and  claviculo-sternal  articulations. 

XII.  With   the   patient   sitting,   the  practitioner,   standing 
behind,  may  place  one  knee  beneath  the  patient's  axilla,  thus 
raising  and  fixing  the  shoulder  and  the  ribs  of  one  side  of  the 
thorax.     This  relieves  the  spine  of  the  weight  of  these  struc- 
tures and  affords  the  practitioner  two  free  hands  with  which 
he  may  manipulate  the  spine  or  opposite  side  of  the  thorax, 
using  the  neck  and  other  arm  of  the  patient  as  levers,  if  desired. 

XIII.  The  ligaments   of   the  posterior  lumbar  and   of   the 
sacro-illac  regions  may  be  thoroughly  relaxed  by  bending  the 
body  of  the  patient,  who  is  sitting,  far  forward  between  his  well- 
separated  knees. 

XIV.  The   same   object   is   accomplished   with   the  patient 
supine,  while  the  legs  and  thighs  are  both  forcibly  flexed  to  their 
limit. 

XV.  To  stretch  the  posterior  scapular,  rhomboid,  and  levator 
anguli  scapulae   muscles,   the  patient  lies  upon  his  back  while 
the  practitioner  slips  one  hand  beneath  the  shoulder  and  grasps 


16  PRACTICE    OF    OSTEOPATHY. 

% 

the  spinal  edge  of  the  scapula,  which  has  been  approximated 
as  closely  as  possible  to  the  spinal  column.  The  other  hand 
holds  the  arm  of  the  patient  just  above  the  elbow,  and  the  arm 
is. raised  and  pushed  across  the  chest,  the  patient's  hand  being 
in  this  way  forced  across  well  into  the  opposite  axilla. 

XVI.  With  the  same  position  of  the  patient,  the  anterior 
scapular  muscles  may  be  reached  by  thrusting  the  fingers  of  one 
hand  deeply  beneath  the  spinal  edge  of  the  scapula,  while  the 
other  hand  grasps  the  point  of  the  shoulder.     Now  the  whole 
lateral  half  of  the  shoulder-girdle  may  be  rotated,  the  first  hand 
continually  working  deeper  beneath  the  scapula. 

XVII.  A  thorough  "breaking  up"  of  the  lower  dorsal  and 
lumbar  regions  of  the  spine  is  accomplished  as  follows:     The 
patient  lies  prone;  the  practitioner  stands  at  the  side  and  passes 
one  arm  beneath  the  thighs  of  the  patient,  just  above  the  knees 
which  he  raises  just  free  of  the  table,  moving  them  horizontally 
— from  side  to  side.     At  the  same  time  his  free  hand  is  applied 
to  the  part  of  the  spine  in  question,  the  thumb  upon  one  side  of 
the  spinous  processes,  -the  fingers  upon  the  other.     The  thumb 
and  fingers  make  lateral  pressure  upon  the  spine,  alternating  with, 
and  in  a  contrary  direction  to,  the  movement  of  the  limbs. 

This  treatment  loosens  and  separates  the  vertebrae,  releases 
tension  of  muscles  and  ligaments,  and  upbuilds  nerve  and  blood- 
action. 

XVIII.  Dr.  Still,  in  case  of  lateral  spinal  lesion,   stands 
in  front  of  the  patient,  who  is  sitting.     He  passes  both  arms 
around  the  body  and  clasps  his  hands  over  the  point  of  lesion; 
"sinks"  the  spine  down  upon  this  point,  bends  the  patient  to- 
ward the  side  of  deviation  of  the  vertebra,  then  with  the  hand 
makes  pressure  upon  the  vertebra  to  force  it  back  to  place  while 
he  rotates  the  body  toward  the  opposite  side. 

Very  many  more  treatments  might  be  described,  but  enough 
general  treatments  have  been  given  to  reach  all  parts  of  the 
spine  and  to  correct  the  lesions  that  are  likely  to  be  met  with 
in  practice.  These  treatments  may  be  combined  or  may  be 
taken  as  the  basis  of  new  ones  which  the  practitioner  may  often 
find  necessary  to  work  out  in  order  to  reach  some  special  lesion 
or  to  treat  some  special  case. 


PRACTICE    OF    OSTEOPATHY.  17 

In  this  portion  of  the  text,  the  treatments  can  of  necessity 
be  described,  and  their  application  be  given,  only  in  a  general 
way.  They  are  outlines  of  methods  of  procedure,  and  the  ap- 
plication of  the  principles  embodied  in  them  must  be  made  to 
the  specific  lesion  met  with  in  a  given  case  by  the  practitioner. 

The  lesions  described  in  Chapter  I,  such  as  lateral  deviation 
of  a  vertebra  or  lateral  swerving  of  a  portion  of  the  column; 
vertebrae  separated  or  approximated;  anterior  or  posterior  lux- 
ations of  vertebrae;  the  "smooth  spine";  the  loss  of  normal  curva- 
ture; the  rigid  or  relaxed  spine,  etc.,  may  all  be  reduced  by  vari- 
ous applications  of  these  treatments. 

Generally  speaking,  the  results  attained  by  the  use  of  these 
treatments  are,  the  relaxation  of  contractured  muscles;  the  re- 
lease of  tension  in  nerve,  muscle,  ligament  or  other  fibrous  struc- 
ture; the  reduction  of  bony  lesion;  the  removal  of  obstruction 
from,  and  the  renewal  of,  blood  and  nerve-currents. 

XIX.  The  fifth  lumbar  vertebra,  after  luxation,  may  be 
restored  in  various  ways.  The  posterior- displacement  is  the  most 
frequent.  In  this  case  one  may  place  the  patient  upon  his 
side,  flex  the  knees  against  one's  abdomen,  fix  the  fifth  lumbar 
by  holding  beneath  it  with  one  hand,  while  the  other,  slipped 
beneath  the  thighs,  rotates  the  weight  of  the  lower  part  of  the 
body  about  the  fixed  point.  Recent  dislocations  may  be  ad- 
justed in  this  way  without  difficulty.  In  long  standing  cases, 
continued  treatment  is  necessary,  the  work  of  relaxation  of  parts, 
etc.,  in  preparation  for  its  reduction,  being  performed  in  part 
by  the  application  of  principles  already  described. 

With  the  patient  upon  his  back  and  the  body  below  the 
fifth  lumbar  protruding  over  the  foot  of  the  table,  the  practit- 
ioner, standing  between  the  limbs  and  holding  one  under  each 
arm,  places  both  hands  beneath  the  pelvis,  makes  a  fixed  point 
at  the  fifth  lumbar,  and  by  th*1  movement  of  his  own  body  ro- 
tates the  lower  half  of  the  patient's  body  about  the  fixed  point. 

With  the  patient  upon  his  back,  the  practitioner  standing 
at  one  side,  the  clenched  hand  is  placed  beneath  the  body  at 
one  side  of  the  fifth  lumbar  spine.  The  leg  and  thigh  are  now 
strongly  flexed  by  the  free  hand,  external  circumduction  of  the 
thigh  is  made,  and  the  weight  of  the  body  is  thrown  onto  the 


18  PRACTICE    OF    OSTEOPATHY. 

fixed  point.  In  some  cases  this  treatment  is  sufficient  for  re- 
placing the  bone. 

In  case  the  vertebra  be  anterior  the  above  treatments  may 
be  applied  for  the  purpose  of  loosening  all  the  ligaments. 

Also  the  principle  of  exaggerating  the  lesion  may  be  ap- 
plied by  making  a  fixed  point  of  the  practitioner's  knee  at  the 
fifth  lumbar,  the  patient  sitting.  The  patient's  body  is  bent 
backward  against  the  fixed  point  and  then  rotated  forward. 
Also,  with  the  patient  sitting  and  the  fifth  lumbar  fixed  with 
one  hand,  the  free  arm  grasps  the  body  of  the  patient  and  ro- 
tates it  about  the  fixed  point.  The  bodies  of  the  vertebrae  may 
be  thus  warped  or  slightly  moved  upon  each  other,  drawing  the 
bone  back  to  place. 

In  many  long-standing  cases  of  bony  lesion,  the  strength- 
ening of  the  surrounding  muscles  and  ligaments  must  take  place 
and  be  depended  upon  to  hold  the  ground  gained  as  the  part  is 
gradually,  during  a  course  of  treatment,  brought  back  toward 
its  normal  position. 

XX.  In  case  the.  sacrum  be  found  to  be  anterior  or  posterior 
from  its  normal  position,  this  is  a  matter  partly  relative  to  the 
position  of  the  innominate  bones,   luxations  of    which   will  be 
discussed  later. 

In  cases  of  posterior  protrusion,  after  relaxation  of  the  sacro- 
iliac  ligaments,  pressure  may  be  made  with  the  knee  directly 
upon  the  sacrum  from  behind,  with  the  patient  either  sitting  or 
lying  upon  his  side.  At  the  same  time  the  pelvis  and  the  upper 
parts  of  the  body  are  drawn  strongly  backward. 

XXI.  In  restoring  the  coccyx  to  normal  position  both  ex- 
ternal and  rectal  treatment  may  be  necessary.     In  some  cases 
external  treatment  alone  will    be    sufficient.     The    sacro-coccy- 
geal  articulation  is  generally  quite  pliable.     In  external  treatment, 
attention  must  be  first  given  to  the  relaxation    of  the    mucles 
and  fibrous  tissues  concerned.     The  bone  may  then  be  grasped 
and  moved  or  sprung  from  either  side  toward  the  median  line, 
may  be  forced  anteriorly,  or  the  finger  may  be  gently  inserted 
beneath  its  tip  and  may  draw  it  back  toward  its  natural  posi- 
tion. 

Rectal  treatment  should  not  be  given  oftener  than  once  a 


PRACTICE    OF    OSTEOPATHY.  19 

week  or  ten  days.  The  patient  lies  upon  his  side  or  bends,  face 
downward,  over  a  table.  The  index  finger,  anointed  with  vase- 
line or  oil  is  inserted,  palm  down,  into  the  rectum.  It  is  then 
turned  palm  up,  laid  along  the  hollow  of  the  coccyx,  and  swept 
from  side  to  side,  to  free  the  action  of  blood-vessels  and  nerves. 
With  the  finger  in  the  rectum  and  the  thumb  outside,  the  bone 
may  be  grasped  and  moved  toward  any  position  necessary. 
As  a  rule  its  restoration  to  a  normal  position  is  only  gradually 
accomplished. 


CHAPTER  III. 
EXAMINATION  OF  THE  NECK. 

INSPECTION  and  PALPATION  are  the  two  physical  methods 
used  in  examination  of  the  neck. 

INSPECTION  reveals  scars  due  to  wounds,  and  suggests  a 
history  of  accident  or  operation.  The  general  conformation  of 
the  neck  should  be  noted. 

Upon  the  anterior  aspect  may  be  seen  enlargement  due  to 
increase  in  the  size  of  the  tonsils  or  of  the  lymphatic  glands; 
abnormal  pulsations  or  engorgement  of  the  blood-vessels;  an 
enlarged  thyroid  gland. 

Upon  the  posterior  aspect  may  be  found  enlargement  of  the 
muscles  or  thickening  of  the  tissues.  Frequently  an  inequal- 
ity of  the  tissues  in  and  below  the  sub-occipital  fossae,  due  to 
thickening  or  to  bony  lesion,  occurs. 

This  inequality  often  indicates  the  existence  of  a  typical 
cervical  condition  of  much  importance  to  the  Osteopath.  So 
frequently  does  one  meet  this  sort  of  a  neck  in  practice,  and  of 
such  importance  are  the  various  lesions  present,  that  its  ready 
recognition  becomes  necessary.  Upon  inspection,  inequality 
is  seen  in  the  postero-lateral  aspects  of  the  neck.  One  side  will 
be  somewhat  hollowed,  and  the  other  side  full.  In  general  ex- 
amination of  the  spine  one  takes  such  condition  as  an  indication 
of  slight  curvature.  Further  examination  show  such  to  be  the 
case  in  the  neck.  The  tissues  are  usually  found,  upon  palpation, 
to  be  tense  and  contract ured  upon  the  full  side.  They  are  as  a 


20  PRACTICE    OF    OSTEOPATHY. 

rule  tender.  The  tissues  upon  the  hollow  side  may  be  in  a  sim- 
ilar condition,  not  usually  so  marked.  Palpation  further  shows 
a  swerving  of  the  cervical  vertebrae,  convexity  to  the  full  side. 
All  or  several  of  the  vertebrae  are  involved,  thus  causing  an  ex- 
tensive cervical  lesion,  capable  of  producing  the  various  ills  due 
to  bony  lesion  of  this  region. 

This  cervical  condition  is  often  found  associated  -with,  and 
may  sometimes  be  due  to.  a  swerve  in  the  spine  below  or  an  in- 
nominate lesion,  changing  the  equilibrium  of  the  spine  and  giving 
a  one-sided  tendency. 

Any  unnatural  position  in  which  the  head  may  be  held 
should  be  noted. 

PALPATION  is  here,  as  elsewhere,  the  important  method  of 
examination.  For  convenience  the  anterior  structures  may  be 
examined  first.  The  patient  lies  upon  his  back,  relaxing  the 
neck  as  much  as  possible.  This  object  may  be  aided  by  the 
practitioner,  placing  one  hand  upon  the  forehead  and  gently 
rolling  the  head  from  side  to  side,  while  with  the  other  he  lightly 
manipulates  the  muscjes  of  the  neck. 

A.  ANTERIOR  STRUCTURES. 

I.  The  tonsil  is  located  by  pressure  of  the  fingers  just  below 
the  angle  of  the  inferior  maxillary  bone.     Any  enlargement  or 
tenderness  of  the  organ  is  to  be  noted.     This  examination  should 
be  supplemented  by  inspection  of  the  throat  internally. 

In  palpation  of  the  tonsil  externally  one  often  feels  an  en- 
larged lymphatic  gland  below  the  angle  of  the  jaw,  accompanying 
the  enlargement  of  the  tonsil,  for  which  it  should  not  be  mistaken. 

II.  Tender    points,  .  frequent    in    catarrhal    conditions,    are 
found  by  deep  pressure  behind  the  angles  of  the  inferior  max- 
illary bones. 

III.  The  hyoid  bone  is  located  by  pressing  all  the  soft  tis- 
sues just  below  the  jaw  toward  the  median  plane  of  the  body. 
This  causes  a  prominence  of  the  greater  cornu  upon  the  opposite 
side  of  the  throat,  which  may  be  easily  detected  by  the  index 
finger. 

The  finger  remains  upon  the  cornu  and  pushes  it  back  to- 
ward the  first  side,  thus  making  prominent  the  greater  cornu  of 


PRACTICE    OF   OSTEOPATHY.  21 

that  side.  With  the  index  finger  and  thumb  upon  the  cornua, 
the  bone  may  be  moved  about  and  a  diagnosis  of  its  position  be 
made.  Contracted  tissues  may  draw  the  bone  upward,  down- 
ward, or  to^one  side. 

IV.  The    hyoid    musdes,    superior    and    inferior,    are    now 
carefully   palpated   to   discover   contracture,    hypertrophy,    con- 
gestion or  tenderness  in  them.     In  public  speakers,  singers,and 
others  liable  to  throat   disease    the  superior  hyoid   muscles  are 
often  in  pathological  condition. 

V.  From  the  hyoid  region,  palpation  is  carried  down  over 
the  thyroid  and  cricoid   cartilages,   noting  whether  their  condi- 
tion be  normal,  arid  is  extended  along  the  throat  structures  to 
the  root  of  the  neck.     In  this  examination  the  parts  are  grasped 
between  the  thumb  and  fingers  of  the  examining  hand  and  are 
moved  from  side  to  side.     At  the  same  time,  deep  but  gentle 
pressure  is  made  at  either  side  of  the  larynx  and  trachea  in  order 
to  note  any  undue  tenderness  in  the  laryngeal  nerves,  as  gener- 
ally revealed Jby  an  impulse  upon  the  part  of  the  patient  to  cough 
or  swallow.     Immobility  or  harshness  of  sound  upon  motion  of 
these  parts  as  above  indicates  abnormal  tension  in  the  related 
muscles  and  other  tissues. 

VI.  Enlargement  or  wasting  of  the  thyroid  gland  or  enlarge- 
ment of  the  cervical  lymphatic  glands  must  be  noted. 

VII.  The    stern o-mastoid    muscle    is    made    prominent    by 
causing  the  patient  to  turn  his  head  to  the  opposite  side.     Pres- 
sure deep  behind  the  anterior  border  of  this  muscle  impinges 
upon  the  pneumogastric  nerve.     Tenderness  in  it  upon  pressure 
may  accompany  liver  or  stomach  disease. 

Its  superior  laryngeal  branch  is  located  by  pressure  behind 
the  greater  cornu  of  the  hyoid  bone.  Note  whether  the  hyoid 
muscles  are  contractured  in  such  a  way  as  to  draw  this  bone 
back  upon  the  nerve. 

Its  recurrent  laryngeal  branch  may  be  impinged  by  pres- 
sure near  the  anterior  border  of  the  sterno-mastoid  muscle  at 
the  level  of  the  cricoid  cartilage.  This  pressure  irritates  the 
larynx  and  causes  the  patient  to  cough  when  the  nerve  is  ten- 
der, as  in  various  throat  affections.  Note  the  condition  of  irrita- 
bility of  the  nerve. 


22  PRACTICE    OF    OSTEOPATHY. 

VIII.  The  phrenic  nerve  arises  from  the  third,  fourth,  and 
fifth  cervical  nerves,  and  may,  at  its  points  of  origin,  be  pressed 
backward  against  the  bony  column.     It  may  be  reached  also 
by  deep  pressure  with  the  thumb  or  finger  in  the  angle  formed  by 
the  posterior  edge  of  the  sterno-mastoid  muscle  with  the  upper 
margin  of  the  clavicle.     This  pressure  must  be  directed  from 
above  diagonally  downward  and  forward  toward  the  sternum. 

IX.  Pressure  of  the  head  directly  downward  upon  the  spinal 
column   with   rotation,    will   sometimes   discover   deep    pain   at 
points  of  lesion. 

X.  With  the  patient  lying  on  his  back,  turn  h'.s  head  well  to 
one  side  and  to  the  other,  noting  any  inequality  in  the  degree  to 
which  it  readily  turns.     Contracted  muscles,  luxated  vertebrae, 
etc.,  often  prevent  its  turning  so  far  to  one  side  as  to  the  other. 

Occasionally  motion  is  so  restricted  (e.  g.,  in  chronic  mus- 
cular or  articular  rheumatism)  that  the  head  can  be  turned 
scarcely  a  fraction  of  an  inch. 

XI.  The  posterior  structures   of   the  neck   may  be   tested 
for  abnormal  tension  by  flexing  the  head  upon  the  thorax,  the 
patient  upon  his  back. 

The  examining  finger  should  follow  the  ligamentum  nuchse 
carefully  up  to  its  insertion  at  the  skull,  where  deep  soreness 
and  contracture  are  sometimes  found  associated  with  headaches. 

XII.  The  palms  of  the  hands  may  be  passed  evenly  over 
the  surface  of  the  neck  to  examine  for  variations  of  tempera- 
ture.    Hot  or  cold  areas  may  be  found.     It  is  common  to  find 
an  area  of  increased  temperature  at  the  base  of  the  skull  behind- 

XIII.  The  state  of  the  blood-vessels  should  be  noted.     A 
strongly  pulsating  carotid  artery  is  seen  in  aortic  regurgitation 
and  in  some  nervous  diseases.     A  venous  pulse  in  the  jugular 
veins    may    accompany    marked    tricuspid    regurgitation.     Con- 
gested veins  of  neck,   chest,  and  face,  especially  if  unilateral, 
may  indicate  pressure  of  a  thoracic  aneurysm  or  tumor.     Often 
one  sees  one  external  jugular  vein  much  fuller  than  its  fellow, 
due  to  narrowing  of  the  space  between  clavicle  and  first  rib. 
Hard,  incompressible,  or  rigid,  carotid  arteries  indicate  arterio- 
sclerosis.    They    are    commonly    accompanied    by    rigidity    and 


PRACTICE   OF    OSTEOPATHY.  23 

tortuosity  of  the  temporal  arteries,  and  by  cardiac  hypertrophy 
and  valvular  lesion. 

B.  POSTERIOR  AND  LATERAL  STRUCTURES. 

I.  With  the  patient  sitting,  the  practitioner  passes  the  ex- 
amining hand  down  along  the  back  of  the  neck.     Just  below 
the  occiput  is  a  depression  in  which  he  may  feel  the  upper  end 
of  the  ligamentum  nuchse  and  the  inner  borders  of  the  trape- 
zius  muscles.     With  the  head  bent  slightly  forward  and  the  ex- 
amining fingers  pressed  deeply  into  this  space  abnormal  tension 
of  these  structures  may  be  noted. 

II.  The  second  cervical  spine  is  the  first  bony  prominence 
felt  below  the  occiput.     The  spines  of  the  third,  fourth  and  fifth 
are  made  out  with  difficulty,  as  they  recede  from  the  surface 
anteriorly.     The  next  palpable  spine  is  that  of  the  sixth,  the 
next  of  the  seventh.     The  latter  is  prominent,  but  not  so  much 
so  as  the  first  dorsal,  from  which  it  must  be  carefully  distin- 
guished. 

There  are  two  ways  to  distinguish  between  them.  The 
sixth  cervical  spine  is  first  located.  While  not  at  all  promi- 
nent it  may  easily  be  felt  as  a  small  point  snugly  resting  upon 
the  upper  surface  of  the  seventh.  Commonly  a  careful  exam- 
ination locates  the  sixth  without  difficulty,  thus  the  seventh  is 
known  to  be  the  next  below,  and  is  distinguished  from  the  first 
dorsal. 

Anterior,  posterior,  or  lateral  deviations  of  the  cervical  verte- 
brae may  be  diagnosed  by  this  examination  of  the  spinous  pro- 
cesses. 

III.  Anterior  dislocations  of  the  upper  three  cervical  ver- 
tebrae may  be  sometimes  noted  by  examining  for  the.  promi- 
nence caused  by  the  body  upon  the  posterior  wall  of  the  pharynx. 
This  is  done  by  passing  the  finger  over  these  bodies. 

IV.  The  position  of  the  atlas  is  examined  as  follows:     The 
patient  lies  upon  his  back  and  the  practitioner  stands  at  the 
head   of   the   table.     The   transverse   processes   are   located   by 
thrusting  the  palms  of  the  examining  fingers  deeply  into  the  space 
between  the  angle  of  the  inferior  maxillary  bone  and  the  tip 
of  the  mastoid  process.     A  finger  is  placed  upon  each  transverse 


24  PRACTICE    OF    OSTEOPATHY. 

process,  which  is  usually  prominent.  Normally  these  processes 
should  be  midway  between  the  angle  of  the  jaw  and  the  tip  of 
the  mastoid  process.  If  they  are  too  far  forward,  too  far  back- 
ward, to  one  side,  or  if  one  be  forward  and  the  other  backward, 
the  diagnosis  is  readily  made  by  comparison  of  the  position  of 
the  processes  relatively  to  the  points  mentioned,  and  the  cor- 
responding displacement  of  the  atlas  is  discovered. 

Occasionally  the  posterior  tubercle  of  the  atlas  may  be  felt 
in  the  space  between  the  second  cervical  spine  and  the  skull. 

In  palpating  the  transverse  processes  of  the  atlas,  care  should 
be  taken  to  feel  out  their  shape  and  contour  fully.  They  vary  ex- 
ceedingly in  size  within  normal  limits,  being  sometimes  so  large 
as  to  extend  below  and  behind  the  mastoid  processes. 

If  the  relations  of  the  atlas  with  the  axis  be  unchanged, 
while  those  of  the  atlas  with  the  skull  are  altered,  we  must  re- 
gard the  head  as  being  displaced  upon  the  atlas. 

V.  Lateral  deviations  of  vertebrae  in  the  neck  are  best  found 
by  examining  the  articular  processes. 

The  head,  with  the  patient  lying  upon  his  back,  is  turned 
to  one  side,  making  prominent  the  row  of  articular  processes 
upon  the  opposite  side.  The  second  cervical  spine  is  now  readily 
located  by  its  prominence  behind,  and  the  finger  traces  from  it 
around  to  the  articular  process  of  the  second,  lying  at  about  the 
same  level,  but  slightly  above.  A  finger  is  held  upon  this  pro- 
cess and  the  head  is  turned  to  the  opposite  side.  The  other  artic- 
ular process  of  the  second  is  then  located  in  the  samp  way.  They 
are  now  compared  while  moving  the  head  slightly  from  side  to 
side,  and  lateral  deviations  or  tenderness  in  the  tissues  are  easily 
made  out.  With  these  two  points  fixed,  the  head  may  be  gently 
turned  from  side  to  side,  and  the  examining  fingers  travel  down 
over  the  successive  articular  processes,  careful  examination  being 
made  of  the  position  of  each. 

VI.  Deep  pressure  may  be  made  from  the  anterior  surface 
of  the  neck  back  upon  the  anterior  aspect  of  the  transverse  pro- 
cesses and  diagnosis  of  anterior  luxation  be  made. 

VII.  Crepitus   and  abnormal  mobility  of  bony  parts  indi- 
cate fracture. 

VIII.  The  patient  lies  on  his  back,   and   the  practitioner 


PRACTICE    OF    OSTEOPATHY.  25 

stands  at  one  side  of  the  head,  turns  the  head  slightly  to  one  side 
and  passes  the  examining  hand  transversely  to  the  course  of  the 
muscle  fibers,  noting  any  contractures  of  the  muscles,  superficial 
or  deep. 

IX.  He  then  stands  at  the  head  of  the  table  and  examines 
both  sides  of  the  neck  at  the  same  time,  a  hand  upon  each  side, 
carefully  comparing  both  sides  with  especial  reference  to  any 
abnormality  either  of  bone  or  of  other  tissue. 

X.  Careful  examination  should  be  made  for  thickening  of 
the  tissues  of  the  neck  just  below  the  occuput.     Sometimes  these 
tissues  may  be  felt  like  a  thick  transverse  band  across  the  back 
of  the  neck  just  below  the  skull.     Such  a  lesion  is  usually  an  in- 
indication  of  intense  congestive  headaches. 

XI.  The  scaleni  muscles  are  made  prominent  upon  one  side 
by  drawing  the  head  to  the  opposite  side.     They  are  normally 
hard  to  the  touch,  and  care  should  be  taken  in  the  diagnosis  of 
contracture.     Tenderness  is   often  found   upon  pressure,   as  in 
cases  of  rheumatism. 

Their  contracture  often  results  in  drawing  the  first  two  ribs 
upward  out  of  place. 

XII.  The  brachial  plexus  of  nerves  emerges  from  between  the 
scalenus  anticus  and   the  scalenus  medius   muscles,   below  the 
level  of  the  fifth  cervical  vertebra.     The  head  is  inclined  to  the 
side  to  relax  these  muscles,  and  deep  pressure  is  made  at  this 
point  to  impinge  the  plexus.     Tenderness  is  thus  revealed.     This 
plexus  may  be  readily  traced  downard  behind  the  clavicle,  and 
along  the  inner  side  of  the  arm. 

XIII.  Tender  areas  are  often  found  upon  pressure  in  the 
sub-occipital  fossae.     They  are  due  to  irritation  of  the  great  and 
small  occipital  and  great  auricular  nerves.     It  is  through  manip- 
ulation of  these  nerves  largely  that  effects  are  gotten  upon  the 
superior  cervical  ganglia  and  upon  the  medulla.     They  are  lo- 
cated at  a  point  about  two  inches  from  the  middle  of  the  post- 
erior  margin   of   the  mastoid  process,  in  a  line  at  right  angles 
thereto  extending  toward  the  median  plane  of  the  neck  pos- 
teriorly.    These  nerves,  when  firmly  pressed,  carry  a  sensation 
of  pain  to  the  top  of  the  head  and  over  it  to  the  brow. 

XIV.  The   superior   cervical   ganglion   lies   in  front   of   the 


26  PRACTICE    OF    OSTEOPATHY. 

transverse  processes  of  the  second  and  third  cervical  vertebrae, 
and  may  be  reached  by  direct  pressure  through  the  tissues. 
The  method  of  locating  the  transverse  process  of  the  second 
"cervical  has  been  given  under  V  of  this  chapter.  Deep  pressure 
from  the  anterior  aspect  of  the  neck  may  press  this  ganglion 
back  against  these  processes.  This  ganglion  lies  in  front  of  the 
rectus  capitis  anticus  muscle,  which  is  penetrated  by  its  branches 
connecting  it  with  the  first  four  cervical  nerves. 

The  middle  cervical  ganglion,  lying  in  front  of  the  trans- 
verse processes  of  the  sixth  and  seventh  cervical  vertebrae,  may 
be  likewise  reached.  This  ganglion  has  branches  connecting  it 
with  the  fifth  and  sixth  cervical  nerves 

The  lower  cervical  ganglion  lies  in  front  of  the  first  costo- 
vertebral  articulation,  and  is  connected  with  the  seventh  and 
eighth  cervical  nerves. 

The  transverse  process  of  the  seventh  cervical  vertebra  is 
readily  located  by  deep  lateral  pressure  at  the  outer  third  of  the 
supra-clavicular  fossa. 

Lesions  of  the  atlas  and  axis  are  by  far  the  most  important 
occurring  in  this  region  of  the  body,  and  account  for  many  ser- 
ious diseases  of  the  head  and  its  parts,  such  as  blindness,  insanity, 
etc.  The  lesions  of  the  neck  hold  an  important  relation  also  to 
diseases  in  other  parts  of  the  body. 

Comparatively  little  treatment  is  given  directly  to  the  head 
and  its  parts.  These  are  treated  largely  through  the  removal 
of  lesion  in  the  neck.  Hence  the  importance  of  most  thorough 
and  careful  attention  to  its  examination. 

The  value  of  gently  moving  a  part  while  under  examination 
in  order  to  relax  tissues,  to  insinuate  the  examining  fingers  more 
deeply  into  them,  and  to  develop  the  latent  lesion  through  in- 
vestigation of  its  relations  to  its  neighboring  parts  during  move- 
ment must  not  be  overlooked. 

CHAPTER  TV. 
TREATMENT  OF  THE  NECK. 

Treatment  of  the  neck,  as  of  other  parts  is,  in  its  specific 
application,  always  removal  of  lesion.  The  following  general 


PRACTICE    OF   OSTEOPATHY.  27 

description  of  methods  of  work  in  treating  the  neck  is  for  the 
purpose  of  laying  before  the  student  in  a  simple  manner  the 
general  principles  involved  in  our  work.  Later  specific  appli- 
cation of  these  general  principles  and  methods  will  be  made. 

I.  With  the  patient   upon  his  back,   the  guiding  hand  is 
laid  upon  his  forehead  and  the  head  is  rolled  gently  from  side  to 
side  a  few  times  to  aid  in  relaxing  the  muscles.     The  fingers  of 
the  operating  hand  are  laid,  palm  down,  upon  the  muscles  of  the 
throat  on  the  side  opposite  to  the  practitioner.     As  the  head  is 
moved  away  from  the  practitioner,  these  muscles  are  loosened 
through  the  shortening  of  that  side  of  the  neck.     At  the  same 
time,  the  operating  hand  draws  these  muscles  toward  the  median 
plane  of  the  neck.     The  head  may  be  now  moved  from  side  to 
side,  Avhile  the  fingers  upon  one  side  of  the  throat  and  the  thumb 
upon  the  other  manipulate  the  tissues.     All  the  tissues  of  the 
anterior  aspect  of  the  throat  may  be  included  in  this  treatment, 
contracture  and  tension  at  any  given  point  being  thus  removed. 
The  treatments  must  be  gentle  in  order  that  sensitive  necks  may 
not  be   irritated. 

The  operating  hand  must  not  be  rubbed  over  the  tissues, 
but  they  must  be  moved  by  the  motion  of  the  hand. 

Holding  or  pressing  gently  but  continuously  against  a  con- 
tracture, while  the  head  is  being  slowly  moved  about,  will  re- 
lieve the  tension  and  remove  the  lesion. 

II.  The  ligaments  of  the  temporo-maxillary  articulations, 
and  the  muscles  and  blood-vessels  below  the  inferior  maxillary 
bone  may  be  relieved  of  tension,  and  be  restored  to  free  action, 
by  springing  the  mouth  open  against  resistance; 

The  patient  lies  upon  his  back  and  the  practitioner  stands 
at  the  head  of  the  table,  placing  the  palms  of  his  thumbs -upon 
the  malar  prominences,  and  the  palms  of  the  fingers  beneath 
the  jaw.  The  patient  is  now  directed  to  open  the  mouth  widely 
and  then  to  gradually  close  it.  Resistance  is  made  by  the  operat- 
ing hands  to  the  first  motion,  and  the  fingers  press  the  superior 
hyoid  muscles  downward  and  forward  toward  the  median  plane 
of  the  neck  during  the  second  motion. 

The  ligaments  of  the  temporo-maxillary  articulations  may 
be  sprung  by  thrusting  a  finger  deeply  into  each  glenoid  fossa 


28  PRACTICE    OP    OSTEOPATHY. 

after  the  patient  has  opened  his  mouth,  holding  them  there  while 
the  mouth  is  shut.     It  is  necessary  to  avoid  hard  pressure  here. 

III.  The  hyoid  bone  may  be  held  between  the  thurhb  and 
finger   and   be   moved   vertically   and   laterally,    stretching   the 
hyoid  muscles. 

IV.  Pressure  may  be  in  some  measure  applied  to  the  pneu- 
mogastric,    glosso-pharyngeal    and    spinal-accessory    nerves    by 
deeply  pressing  the  finger  upward  and  inward  behind  the  angle 
of  the  jaw,  in  the  direction  of  the  jugular  foramen. 

The  pneumogastric  nerve  may  be  manipulated  by  deep  pres- 
sure behind  the  anterior  border  of  the  stern o-mastoid  muscle. 

These  three  nerves  are  also  influenced  by  manipulation 
upon  their  closely  related  nerves,  the  sub-occipital,  great  occipi- 
tal, small  occipital,  and  great  auricular,  reached  in  the  sub- 
occipital  fossae  as  above  described. 

V.  Pressure  upon  the  phrenic  nerve  may  be  applied  at  the 
points  described  in  Capter  III. 

VI.  The  sterno-mastoid   muscle   may  be   manipulated,   fol- 
lowing the  method  described  for  treatment  of  muscles  of  the 
throat  under  I  of  this  chapter. 

The  muscle  upon  one  side  may  be  stretched  by  turning  the 
head  toward  that  side  and  slightly  upward,  thus  increasing  the 
distance  between  the  mastoid  process  and  the  sterno-clavicular 
origin  of  the  muscle. 

VII.  The  lateral  and  posterior  muscles  of  the  neck  may  all 
be  treated  in  a  manner  similar  to  that  described  under  I  of  this 
chapter. 

The  practitioner  may  also  stand  at  the  head  of  the  table, 
and  with  the  palms  of  the  hands  upon  each  side  and  the  back 
of  the  neck,  gently  grasp  handsfull  of  the  muscles,  manipu- 
lating them  thoroughly  while  slowly  moving  the  head  in  all 
directions.  Pressure  and  manipulation,  together  with  motion, 
all  gently  and  patiently  applied,  will  relax  the  most  obstinate 
contracture,  loosen  all  deep  fibrous  structures,  free  blood-ves- 
sels and  nerves,  and  prepare  the  way  for  what  is  usually  the 
real  object  of  the  treatment,  the  reduction  of  bony  lesions. 

VIII.  With  the  patient  supine,  the  head  is  pushed  as  far 
as  may  be  easily  done  without  resistance,  first  to  one  side  and 


PRACTICE   OF    OSTEOPATHY.  29 

then  to  the  other,  and  it  is  noticed  whether  it  turns  as  far  to  one 
side  as  to  the  opposite  side.  Inequality  between  the  two  sides 
indicates  lesion  usually  upon  the  side  toward  which  the  head 
turns  least  easily. 

After  relaxation  of  the  tissues,  turning  the  head  to  its  limit 
toward  each  side  will  sometimes  aid  in  the  reduction  of  bony 
lesion,  especially  with  the  aid  of  pressure  applied  to  force  the 
part  into  its  place. 

IX.  (1)  In  lesion  of  the  atlas  the  patient  lies  supine  and 
the  practitioner,  standing  at  the  head  of  the  table,  holds  the  head 
between  the  hands,  with  a  thumb  or  finger  upon  each  transverse 
process.  The  head  is  now  moved  in  a  direction  to  exaggerate 
the  lesion,  and  with  traction,  rotation,  and  pressure  upon  the 
processes,  the  atlas  is  forced  toward  its  position. 

(2)  The  operator  may  stand  at  the  side  of  the  head,  one 
hand  upon  the  forehead  and  the  other  pressed  firmly  just  below 
the  skull,  in  the  region  of  the  lateral  arch  of  the  atlas,  on  the 
opposite  side.     Exaggeration  of  the  lesion,  rotation,  .and  strong 
pressure  aid  in  replacing  the  part. 

(3)  The  patient  sits  and  the  practitioner,  standing  in  front, 
places  one  knee  beneath  the  chin,  while  the  hands  grasp  the 
sides  and  back  of  the  head,  and  the  fingers  are  firmly  pressed  upon 
the  lateral  arch  of  the  atlas  upon  each  side.     Exaggeration  of 
the  lesion,  traction,  pressure,  and  rotation  are  now  applied  as 
before.     The  chin  is  slightly  raised  and  drawn  forward  by  motion 
of  the  knee  beneath  it.     The  head  is  rocked  upon  the  atlas  gently, 
the  requisite  pressure  being  made  upon  the  lateral  arches  to  press 
the  bone  back  to  its  position. 

(4)  The  patient  sits  and  an  arm    is  passed  about  his   head, 
the  bend  of  the  elbow  coming  beneath  the  occipital  protuber- 
ance and  the  hand  beneath  the  chin.     The  head  is  now  forci- 
bly raised  with  the  idea  of  moving  it  upon  the  spine  in  the  de- 
sired direction,  while  the  free  hand  makes  pressure  upon  the 
spine  or  neck  in  the  direction  necessary  to  aid  in  reposition. 

(5)  Dr.   Still  uses  the  following  movement  in  setting  the 
atlas.     He  stands  in  front  of  the  patient,  who  is  sitting,  and 
clasps  his  hands  behind  the  neck,  just  below  the  skull,  pressing 
the  pisiform  bones  firmly  'against  the  lateral  arches  of  the  atlas. 


30  PRACTICE    OF    OSTEOPATHY. 

Now  the  proper  movement  is  made  to  rotate  the  head  to  the 
affected  side,  "sinking"  it  down  upon  the  spine,  and  to  press  the 
atlas  into  place. 

(6)  With  the  patient  lying  upon  his  back,  the  practitioner 
stands  at  the  head  of  the  table,  holds  the  head  between  his  hands, 
presses  his  fingers  against  the  lateral  arches  of  the  atlas,  while 
the  head  is  slightly  raised  from  the  table  and  supported  by 
pressure  from  his  own  body,  pressing  it  down  upon  the  spine. 
Now  the  proper  movement  is  made  to  exaggerate  the  defect, 
rotate  the  head,  and  press  the  atlas  into  place. 

These  various  treatments  may  be  applied  to  any  of  the 
usual  lesions  of  the  atlas.  The  same  principles  may  be  applied 
to  the  different  malpositions  of  any  of  the  cervical  vertebrae. 
Generally  patience  and  time  are  necessary  to  the  gradual  res- 
toration of  the  bones  to  place.  Much  attention  must  be  given 
to  the  thorough  and  gradual  loosening  of  all  parts  in  preparation 
for  replacement. 

X.  The  axis  is  generally  displaced  laterally.     The  tissues 
upon  its  transverse  and  articular  processes  are  quite  tender  and 
contractures  are  found  in  the  muscles  about  it.     Exaggeration 
of  lesion,  rotation  and  pressure  usually  restore  it  to  place. 

XI.  The  scaleni  muscles  may  be  stretched  by  pressing  the 
head  down  toward  the  side  in  question,  pressing  the  fingers  be- 
hind the  clavicle  upon  the  first  rib  to  force  and  hold  it  down, 
while  the  head  is  now  drawn  to  the  opposite  side. 

XII.  Thorough   loosening    of   all    cervical    tissues    may    be 
accomplished  by  a  somewhat  "spiral"  treatment.     The  patient 
lies  on  his  back,  the  guiding  hand  is  placed  upon  the  forehead, 
and  the  other  hand  is  slipped  beneath  the  neck  and  grasps  it. 
The  head  and  neck  are  now  raised  slightly,  the  head  being  ro- 
tated in  one  direction,  while,  as  far  as  possible,  exactly  the  op- 
posite motion  is  given  the  neck.     The  hand  travels  up  and  down 
the  neck  treating  its  different  portions  alike. 

XIII.  Flexing  the  head  strongly  upon  the  thorax  stretches 
the  ligamentum  nuchse  and  posterior  tissues  of  the  neck. 


PRACTICE    OF    OSTEOPATHY.  31 

CHAPTER  V. 

OSTEOPATHIC  POINTS  CONCERNING  THE  HEAD  AND  ITS  PARTS. 

As  stated,  the  chief  lesions  affecting  the  head  and  its  parts 
occur  in  the  neck,  and  have  already  been  described.  More 
detailed  points  in  examination  and  treatment  of  these  important 
structures  will  be  considered  in  lectures  upon  their  specific  dis- 
eases in  the  second  part  of  this  work.  The  present  chapter  will 
embrace  only  general  osteopathic  points. 

INSPECTION  AND  PALPATION  are  the  methods  of  examina- 
tion. By  the  former  one  notes  the  size  and  shape  of  the  skull, 
the  complexion,  expression,  eyes,  etc.  By  palpation  he  notes 
the  presence  of  tumors  or  other  growths,  open  fontanelles,  etc. 

A.  THE  EYE. 

Those  lesions  most  frequently  affecting  these  organs  occur 
at  the  atlas  and  axis,  and  along  the  cervical  and  upper  dorsal 
regions  as  low  as  the  fifth  dorsal  vertebra. 

I.  The  conjunctiva  lining  the  lids  may  be  examined.     The 
lower  lid  is  drawn  out  and  down,  pressure  being  made  at  the 
same  time  below  it,  causing  it  to  become  prominent. 

The  upper  lid  is  turned  back  by  grasping  the  edge  slightly 
toward  the  outer  canthus  and  raising  the  lid,  while  at  the  same 
time  pressure  is  made  upon  it  from  above  near  the  inner  canthus. 
This  inverts  the  tarsal  cartilage  and  exposes  the  membrane. 

If  while  this  lid  is  turned  back  the  lower  one  is  also  treated 
as  above,  both  together  stand  out  more  prominently  and  may 
be  observed  together. 

Granulations  appear  as  minute  white  or  pale  red  elevations. 

II.  With  the  patient  supine,  direct  pressure  is  made,  with 
the  palms  of  the  fingers,  upon  the  eye-balls,  pressing  them  di- 
rectly back  into  the  orbits.     This  impinges  nerves,  blood-vessels, 
muscles  and  all  the  orbital  structures.     It  presses  excess  of  blood 
from  the  vessels,  and  tones  the  muscles,  nerves  and  the  struc- 
tures of  the  intra-ocular  mechanism. 

III.  Tapping  upon  the  eyeball  has  much  the  same  effect.    It 
is  performed  by  placing  the  palms  of  one  or  two  fingers  over  the 
closed    eye,    and   lightly   tapping   them   with   the   index   finger. 


32  PRACTICE   OF    OSTEOPATHY. 

Toning  of  the  nerves,  of  the  ball  and  its  structures,  and  of  the 
optic  nerve  is  thus  accomplished. 

IV.  Granulations   are   crushed   by   squeezing   them  beween 
the  finger  and  thumb,  the   finger  being  inserted  beneath  the  lid. 

V.  In  pterygia,   the  small  blood-vessels  formed  upon  and^ 
in  the  corneal  conjunctiva  as  feeders,  may  be  broken  up  by  draw- 
ing the  back  portion  of  the  edge  of  the  finger-nail  across  them. 
Care  must  be  taken  not  to  wound  the  conjunctiva. 

VI.  In  strabismus  the  weakened  or  tensed  muscle  may  be 
treated  by  pressing  the  fingers  into  the  orbit  about  the  eyeball. 

B.  THE  FIFTH  NERVE. 

This  nerve  is  reached  at  various  points  about  the  head,  as 
it  sends  many  branches  out  over  the  head  and  face.  Its  treat- 
ment is  especially  important  in  headaches,  neuralgias,  diseases 
of  the  eye,  nose,  etc.,  for  the  reason  that  it  carries  vaso-motor 
and  trophic  fibres  to  these  parts. 

I.  Its  supra-orbital  branch  may  be  traced  from  the  supra- 
orbital  foramen  out  over  the  forehead  to  the  temple.     It  forms 
an  angle  of  about  fifty  degrees  with  the  superciliary  ridge.     It 
may  be  felt  under  the  skin  like  a  fine  whip-cord,  and  it  may  be 
manipulated  along  its  course  by  passing  the  fingers  transversely 
across  it.     Often  one  nerve  is  more  plainly  felt, and  often  one  is 
more  tender,  than  its  fellow.     Though    not  invariably    so,  it  is 
often  noticed  that  the  nerve  which  is  seemingly  slightly  enlarged 
and  more  plainly  felt  is  the  one  in  abnormal  condition. 

II.  The  infra-orbital  and  mental  branches  may  be  manip- 
ulated at  their  respective  foramina. 

By  clinching  the  fingers  beneath  the  malar  process  several 
branches  of  the  former  may  be  impinged. 

The  tissues  over  the  foramina  and  along  the  courses  of  all 
of  these  different  branches  should  be  thoroughly  relaxed  to  re- 
move irritation. 

III.  A  supra-trachlear  branch  is  located  slightly  to  the  outer 
side  of  the  mid-line  of  the  forehead,  a  lachrymal  branch  about  the 
middle  of  the  upper  eyelid,  a  temporal  branch  external  to  the 
outer  canthus  of  the  eye,  an  infra-trochlear  branch  upon  the  nose 
opposite  the  inner  canthus,  and  a  nasal  branch  at  the  lower  third 
of  the  side  of  the  nose. 


PRACTICE    OF    OSTEOPATHY.  33 

All  are  subcutaneous  and  are  readily  manipulated  after 
knowing  where  to  locate  them. 

THE  EAR. 

With  the  EAR,  as  with  the  eye,  lesion  of  the  atlas,  axis,  or 
upper  cervical  region  is  the  most  usual  cause  of  disease. 

The  auricle  should  be  drawn  up  and  back  in  order  that  the 
external  canal  may  be  inspected  for  the  presence  of  growths, 
boils,  foreign  objects,  discharges,  etc. 

Attention  should  be  given  to  the  condition  of  the  cerumen. 
It  is  sometimes  seen  to  be  dry  and  flaky,  indicating  poor  circu- 
lation and  imperfect  secretion.  Or  it  may  be  abundant,  forming 
a  plug,  which  gathers  in  the  deeper  part  of  the  canal  and  obscures 
the  drum,  generally,  but  not  always,  impairing  or  quite  obstruct- 
ing the  hearing  in  that  ear.  If  it  presses  upon  the  drum  it  is  apt 
to  cause  vertigo,  or  a  sense  of  congestion  in  the  head. 

In  some  cases  the  cerumen  will  be  found  to  be  entirely  or 
almost,  lacking,  in  one  or  both  ears.  This  commonly  indicates 
greatly  impaired  local  circulation,  due  to  cervical  lesions,  poor 
general  health,  or  both.  In  many  cases  treatment  has  restored 
the  normal  secretion  of  wax. 

Itching  and  extreme  tenderness  of  the  canal  are  sometimes 
noted. 

The  head-mirror  and  ear-speculum  should  be  employed  in 
the  examination  of  the  deeper  parts  of  the  canal,  and  of  the  tym- 
panum. Sometimes  a  plug  of  cerumen  can  be  detected  by  this 
means  only. 

By  the  use  of  these  instruments  the  student  should  become 
familiar  with  the  appearance  of  the  normal  drum.  A  good  text- 
book, with  its  illustrated  plates,  showing  the  appearance  of-  the 
various  abnormal  conditions  of  the  drum,  is  a  valuable  aid  to 
this  study. 

The  patient  should  be  instructed  to  close  the  mouth,  hold 
the  nostrils  shut,  and  blow.  This  will  reveal  whether  or  not  the 
Eustachian  tubes  are  open,  by  the  presence,  or  lack,  of  the  crack- 
ling sound  and  sensation  of  fulness  in  the  ears  as  the  air  is  forced 
against  the  inside  of  the  drum. 

When  this  act  is  performed,  a  perforation  of  the  drum  is 


34  PRACTICE    OF    OSTEOPATHY. 

betrayed  by  the  whistling  of  the  air  through  the  aperture,  or  by 
the  gushing  through  it  of  secretions  or  pus  from  the  middle  ear. 

Impaired  hearing  may  be  due  to  fault  in  the  outer,  middle  or 
inner  ear,  auditory  nerve,  or  brain  center.  A  watch  is  a  very 
handy  and  delicate  instrument  to  employ  in  testing  the  hearing. 
This  should  be  done  in  a  quiet  room.  First  the  watch  should  be 
held  quite  close  to  the  ear,  and  gradually  removed  from  it,  to 
test  the  distance  at  which  the  ear  may  catch  the  ticking.  Both 
ears  should  be  tested  in  this  way.  •  The  less  acute  power  of  one 
ear  is  often  thus  discovered.  Sometimes  the  watch  may  not  be 
heard  to  tick  unless  pressed  close  against  the  auricle.  The  ear 
which  stands  this  simple  test  is  sound,  as  to  its  hearing  power, 
throughout  the  auditory  mechanism. 

If  the  ear  fails  to  hear  the  ticking  when  the  watch  is  held 
near  or  against  the  auricle,  the  watch  should  then  be  held  rather 
firmly  against  the  upper  part  of  the  mastoid  process,  just  behind 
the  auricle.  If  now  the  hearing  fails,  the  trouble  lies,  probably, 
in  the  inner  ear,  but  may  be  located  in  either  the  auditory  nerve 
or  in  the  brain  center.  As  a  matter  of  fact,  the  causes  of  deafness 
lie,  for  the  most  part  in  the  middle  or  inner  ear,  or  in  the  Eus- 
tachian  tube,  being  rarely  referable  to  the  auditory  nerve  proper 
or  to  the  center.  Deafness  due  to  causes  affecting  nerve  or 
center  may  be  distinguished  from  strictly  aural  deafness  in  a 
simple  way.  In  the  former  case  the  ticking  can  be  heard  only 
faintly  or  not  at  all  whether  the  watch  be  held  away  from  the 
ear  or  be  brought  near  to  it  or  pressed  against  the  auricle  or  the 
mastoid.  But  in  the  latter  the  watch  may  be  heard  more  dis- 
tinctly when  it  is  held  against  the  mastoid,  since'  by  bone  con- 
duction the  sound  is  carried  to  the  nerve. 

Sometimes  the  test  is  applied  by  having  the  watch  held  be- 
tween the  teeth.  If  the  Eustachian  tube  is  occluded  the  sound 
is  heard  less  distinctly  upon  the  affected  side.  But  if  the  ob- 
struction is  in  the  middle  ear,  as  from  thickening  of  the  tissues 
and  rigidity  of  the  ossicles,  the  sound  may  be  heard  more  dis- 
tinctly upon  the  affected  side  (through  conduction).  Some- 
times, also,  this  occurs  when  there  are  impactions  of  cerumen 
against  the  membrana  tympani. 

Tinnitus  Aurium,   or  "ringing  of  the  ears,"  consists  of  a 


PRACTICE    OF    OSTEOPATHY.  35 

variety  of  subjective  sounds  due  to  nervous  disease,  anemia, 
catarrhal  conditions,  and  various  other  causes.  Generally  speak- 
ing, the  dull,  throbbing  or  buzzing  noises  are  due  to  obstructed 
circulation  in  the  ear,  especially  in  the  fine  capillary  network 
spread  upon  the  drum.  This  commonly  results  from  colds  and 
catarrhal  affections.  This  class  can  often  be  bettered. 

On  the  other  hand,  ringing,  screeching,  or  whistling  Aoises 
commonly  denote  some  affection  of  the  nerves  of  the  auditory 
apparatus,  as  is  sometimes  seen  resulting  from  lagrippe.  These 
cases  are  usually  difficult  to  help  much. 

Of  the  discharges  from  the  ear,  pus  and  blood  are  the  most 
significant,  and  their  source  should  be  carefully  sought. 

Treatment  of  the  ear  is  discussed  under  the  heading  of  Dis- 
eases of  the  Ear. 

THE  NOSE. 

In  the  examination  of  the  nose  its  external  aspect  should  be 
noted.  Deformities  from  operation,  violence,  or  disease  are 
common.  The  nose  often  indicates  chronic  catarrh  by  being 
bent  somewhat  to  one  side,  following  ulceration  of  bones  or 
cartilages,  or  surgery. 

A  peculiar  "club-shaped"  nose,  with  a  large,  rounded  end 
is  sometimes  seen  in  the  scrofulous. 

A  red,  or  livid  nose,  with  enlarged  and  injected  vessels,  is 
a  common  indication  of  bibulous  habits,  and  this  member  some- 
times becomes  grossly  hypertrophied  and  deformed  by  excessive 
indulgence  in  alcoholic  beverages.  Redness  of  the  nose  very 
often  results  from  congestion  due  to  chronic  valvular  heart-dis- 
ease, from  congestion  of  the  liver,  or  from  tight-lacing  in  women. 

The  internal  examination  should  be  made  by  use  of  a  con- 
venient dilator,  head-mirror  and  speculum.  The  examiner 
should  note  the  condition  of  the  mucous  membrane  for  redness 
or  inflammation  or  for  paleness  and  atrophy  as  in  chronic  catarrh. 

The  character  of  the  secretions  and  discharges  should  be  noted, 
and,  if  abnormal,  their  source  or  cause  carefully  sought.  Very 
offensive  mucous  discharges  and  pus  indicate  advanced  catarrhal 
conditions,  and  may  result  from  ulceration  in  the  tissues  of  the 
nose  or  from  abscess  or  ulceration  in  the  frontal  sinus  or  antrum. 


36  PRACTICE    OF   OSTEOPATHY. 

Bleeding  is  usually  from  the  membrane  and  due  to  local 
irritation,  or  from  congestion  of  the  vessels  of  the  head,  causing 
rupture  of  small  vessels.  After  violence  one  should  consider 
the  probability  of  fracture  of  the  base  of  the  skull  as  a  source  of 
bleeding. 

Foreign  bodies ;  growths,  such  as  polypi  and  adenoids;  "spurs" 
of  bone,  due  to  hypertrophy  resulting  from  catarrh;  enlargement 
of  the  middle  or  inferior  turbinated  bones ;  or  a  deflected  septum 
may  be  found. 

The  NOSE,  apart  from  neck  treatment,  is  sometimes  treated 
by  local  manipulation. 

I.  Manipulating    and   loosening    all    the    tissues    along    the 
sides  of  the  nose  affects  the  blood-supply  of  its  mucous  mem- 
brane through  branches  of  the  fifth  nerve.     It  will  also  operate 
to  free  the  channel  of  the  nasal  duct. 

II.  With  the  patient  supine,  the  palm  of  the  hand  is  placed 
upon  the  forehead,  the  other  hand  is  laid  upon  the  first,  and  the 
practitioner,  bending  over  the  head  of  the  table,  brings  his  weight 
.upon  the  patient's  forehead.     This  pressure  is  continued  several 
seconds  and  repeated  a  few  times.     It  frees  the  nostrils  and  in 
acute  colds  frequently  at  once  restores  freedom   of  breathing 
through  the  nose. 

The  affect  is  probably  gotten  by  the  pressure  affecting  the 
branches  of  the  fifth  nerve  upon  the  forehead.lt  is  greatly  in- 
creased by  first  applying  momentary  pressure,  with  the  thumbs, 
to  the  internal  jugular  veins,  which  are  thus  dilated  back  to  the 
capillaries  by  the  pent-up  blood,  after  which  they  carry  away 
more  blood,  relieving  the  congested  head  and  mucous  membrane 
of  the  nose. 

III.  In  colds  and  catarrh,  pain  in  the  frontal  sinus  may  be 
relieved  by  tapping  with  the  knuckles  upon  the  frontal  bone 
over  the  sinus. 

The  MOUTH  and  THROAT  are  sometimes  treated  internally 
by  sweeping  the  palm  of  the  index  finger  from  the  mid-line  of 
the  posterior  portion  of  the  hard  palate  outward  and  downward 
over  the  soft  palate,  pillars  of  the  fauces,  and  tonsils.  The 
uvula  may  also  be  touched.  The  nerves  and  blood-vessels  of 
this  region  are  thus  toned. 


PRACTICE   OF   OSTEOPATHY.  37 

The  Uvula,  being  thus  treated  by  digital  application,  elonga- 
ations  of  it  are  overcome  through  restoring  tone  to  its  muscles 
and  vessels.  It  is  usually  elongated  by  conditions  which  con- 
gest it  and  the  surrounding  tissues,  and  the  elongation  is  due  to 
the  loss  of  tone  thus  induced  in  the  azygos  uvulae  muscles.  This 
condition  is  often  the  cause  of  a  little  hacking  cough  in  children. 

THE  TEMPORO-MAXILLARY  ARTICULATIONS  are  examined. 
Inequality  in  their  action  is  discovered  by  standing  behind  the 
head  of  the  patient,  who  is  lying  supine.  The  mouth  is  opened 
and  closed,  and  deviation  of  the  mid-line  of  the  chin  from  the 
median  plane  of  the  body  noted.  Deviation  of  this  nature  in- 
dicates luxation  of  one  of  the  articulations,  the  jaw  usually  de- 
viating away  from  the  side  of  the  lesion,  though  often  toward  it, 
by  reason  of  tightened  condition  of  the  articulation  on  the  affected 
side. 

I.  The  ligaments  of  the  articulation  may  first  be  loosened 
as  described  under  II  of  Chapter  IV.     Pressure  upon  the  op- 
posite jaw  while  the  patient  is  closing  the  mouth  will  bring  the 
condyle  back  into  place, 

II.  Sometimes  it  is  necessary  to  place  a  small  cork  or  piece 
of  wood  between  the  posterior  molar  teeth  upon  the  affected  side. 
Pressure  is  now  made  beneath  the  chin,  tending  to  close  the 
mouth,  and  the  jaw  is  slipped  into  place.     The  corks  may  be  in- 
serted at  the  same  time  between  the  molars  of  both  sides  in  case 
of  bilateral  luxation. 

Treatment  I,  may  be  alternately  applied  in  such  case. 

Opening  the  mouth  against  resistance  (II,  Chap.  IV),  man- 
ipulation of  the  throat  to  free  the  action  of  the  carotid  arteries, 
and  treatment  of  the  superior  cervical  region  (XIII,  Chap.  Ill) 
are,  together  with  removal  of  specific  lesions,  the  chief  metkods 
of  treatment  in  diseases  of  the  eye,  ear,  nose  and  throat.  They 
produce  affects  by  building  up  the  blood-supply. 

Treatment  along  the  mid-line  of  the  skull,  from  the  nasion 
to  the  occipital  protuberance,  thence  outward  along  the  sides 
of  the  head,  affects  the  circulation  in  the  longitudinal  and  lat- 
eral sinuses  through  connected  nerves  and  veins.  It  also  affects 
the  sensory  nerves  of  the  scalp,  they  congregating  about  the 
vertex. 


38  PRACTICE    OF   OSTEOPATHY. 

CHAPTER  VI. 
EXAMINATION  OF  THE  THORAX. 

From  an  Osteopathic  point  of  view,  and  not  at  present 
considering  the  contents  of  the  thoracic  cavity,  the  examina- 
tion of  the  thorax  consists  mainly  in  discovering,  by  palpa- 
tion and  inspection,  whether  its  bony  structures  are  all  in  posit- 
ion. 

Ligamentous  and  muscular  lesions,  also  lesions  of  blood- 
vessels, nerves,  and  centers  are  closely  associated  with  bony 
lesions. 

The  relations  of  the  thorax  to  the  spine  as  a  whole  and  to  its 
own  contained  viscera  cause  its  lesions  to  be  among  the  most 
important  ones  found  in  the  body.  Lesion  of  the  spine,  especially 
of  its  thoracic  portion,  often  seriously  affects  the. thorax  proper. 

INSPECTION  reveals  change  in  the  general  conformation  of 
the  thorax.  It  is  made  with  relation  to  the  spine,  and  effects 
of  spinal  irregularities  are  considered.  Flattening  or  promi- 
nence of  the  ribs,  either  in  portions  of  the  thorax  or  affecting 
it  as  a  whole;  restriction  or  increase  in  the  movements  of  the 
thorax,  upon  one  or  both  sides;  color  of  the  skin,  eruptions, 
scars,  etc.,  are  all  noted. 

Change  in  the  general  conformation  of  the  thorax  is  sig- 
nificant of  the  presence  of  many  lesions.  Often  a  single  glance 
assures  the  examiner  of  the  presence  of  many  lesions  which  are 
closely  related,  and  which,  as  experience  teaches,  are  all  in  a 
train  of  abnormalities,  so  that  he  is  practically  sure  from  the  be- 
ginning that  he  will  find  present  certain  various  lesions.  A 
weakened  condition  of  the  spine,  allowing  of  lateral  swerving  of 
its  vertebrae  or  of  changes  in  its  normal  curves  is  apt  to  be 
found  causing  a  weakness  of  the  costo-vertebral  ligaments.  The 
ribs  are  therefore  not  held  in  their  proper  relation  to  the  spine, 
the  whole  thorax  is  weakened,  and  the  ribs  sag  downward,  narrow- 
ing the  antero-posterior  diameter  of  the  chest,  or  otherwise  dis- 
torting it.  The  foundation  is  thus  laid  for  the  various  diseases 
of  heart,  lungs,  etc.  The  angles  of  the  ribs  are  approximated 
and  become  prominent  along  the  postero-lateral  aspects  of  the 


PRACTICE    OF   OSTEOPATHY.  39 

chest,  or  "stand  out  in  rings  under  the  shoulders,"  as  Dr.  Still 
says.  This  narrows  the  thorax  so  that  a  lateral  view  of  it  shows 
the  axillary  and  infra-axillary  regions  narrowed,  and  the  examining 
hand  swept  down  along  the  angles  finds  the  lateral  span  of  the 
chest  much  decreased.  The  two  sides  may  differ.  The  ilio- 
costal  spaces  are  narrowed,  sometimes  to  the  extent  of  oblitera- 
tion. 

In  case  of  a  lateral  swerve  of  the  spine  the  ribs  upon  the 
convex  side  are  found  to  be  more  oblique,  and  their  inter-spaces 
are  narrowed  or  obliterated.  At  the  same  time  the  whole  thorax 
may  be  altered  in  shape  as  above  described. 

The  patient  may  sit,  lie,  or  stand  during  inspection,  as  most 
convenient. 

PALPATION,  the  more  important  method,  proceeds  in  con- 
junction with  further  inspection,  and  is  used  in  the  detection 
of  the  various  special  lesions  to  be  described. 

I.  With  the  patient  standing  or  sitting,  the  palms  of  the 
hands  are  passed  evenly  over  the  anterior  and  posterior  aspects 
of  the  chest,  comparing  side  with  side;  region  with  region.     The 
temperature  is  also  noted. 

II.  The  precordial  region  is  examined  for  any  protrusion  or 
retraction  of  the  thoracic  wall,  significant  with  relation  to  heart- 
disease. 

III.  Each  lateral  half  of  the  chest  is  examined  for  change 
or  lessening   of   its   antero-posterior   diameter,    considering    the 
direction  of  the  component  ribs  as  well.     Lessening  of  this  di- 
ameter, and  a  tendency  of  the  ribs  to  greater  obliquity  in  direction, 
reveals  a  flattened  side  or  sides  of  the  chest.     This  shows  spinal 
lesion  generally,  also  disturbed  ligaments,  blood-vessels,  nerves, 
etc.,  of  all  related  parts.     In  this  case  the  whole  side  is  dropped 
down  and  the  ilio-costal  space  is  lessened. 

People  with  such  lesions  are  always  poor  breathers  because 
of  the  extra  effort  required  of  weakened  muscles  to  raise  the  dis- 
arranged ribs.  They  therefore  suffer,  in  addition  to  the  results 
of  specific  lesion,  from  the  various  evils  of  congestion  and  im- 
perfect oxygenation  consequent  upon  poor  rib,  chest,  and  lung 
action. 

IV.  The  same  lesion  may  affect  a  portion  of  the  thorax. 


40  PRACTICE    OF    OSTEOPATHY. 

Often  a  flattening  of  the  ribs  posteriorly  beneath  the  scapula  is 

found. 

Protrusions  or  retractions  of  one  area  of  the  chest  generally 
correspond  with  the  reverse  condition  in  the  corresponding  an- 
terior or  posterior  area.  This  is  not  true  in  case  of  slipping  of 
the  ribs  downward. 

V.  Marked  depressions  in  the  supra  or  infra-clavicular  re- 
gions are  significant  in  the  diagnosis  of  tuberculosis  of  the  lungs. 

VI.  With  the  patient  lying  on  his  side,  the  palm  of  the  hand 
is  swept  along  the  lateral  and  postero-lateral  aspects  of  the  chest, 
from  the  shoulder  downwards.     Changes  in  the  position  of  the 
ribs  individually,  or  in  the  conformation  of  the  side  of  the  thorax 
in  question  are  thus  readily  made  out,  mainly  by  detection  of 
changes  in  the  angles  of  the  ribs  from  normal. 

The  STERNUM  must  be  examined. 

I.  It  may  be  as  a  whole,  protruded  or  retracted,  following 
a  change  in  the  general  shape  of  the  thorax. 

II.  Luxation  between  the  first  and  second  parts,  anteriorly 
or  posteriorly,  may  occur. 

III.  The  ensiform  may  be  displaced  laterally. 

THE  CLAVICLE  AND  CORACOID. 

The  latter  is  located  as  the  first  bony  prominence  at  the  outer 
end  of  the  infra-clavicular  fossa.  Its  relation  to  the  clavicle  is 
to  be  noted,  also  the  condition  of  the  tissues  attaching  to  it. 

The  clavicle  may  be  luxated  at  either  its  sternal  or  acro- 
mial  articulation.  The  sternal  end  may  be  upward,  anteriorly 
or  posteriorly  from  its  normal  position.  The  acromial  end  may 
be  displaced  downward  toward  the  coracoid  or  upward  upon  the 
acromion  process.  Sometimes  the  bone  is  tilted  so  that  one's 
fingers  may  be  thrust  for  behind  its  upper  edge.  These  lesions 
are  generally  easily  detected  by  inspection  and  palpation.  The 
examination  of  the  sternal  end  is  often  facilitated  by  having  the 
patient  lie  flat  upon  his  back,  then  pressing  the  tip  of  the  examin- 
ing finger  down  deeply  upon  the  sterno-clavicular  junction,  at 
the  same  time  comparing  it  with  its  fellow,  which  should  be  felt 
out  by  the  other  hand.  Very  slight  depressions  or  elevations 
may  be  thus  detected,  as  may  also  tenderness. 


PRACTICE    OF   OSTEOPATHY.  41 

Dr.  Still  points  out  that  in  diseases  of  the  throat  the  ster- 
nal end  of  the  clavicle  is  often  found  displaced  backwards  against 
the  pneumogastric  nerve,  irritating  it  and  causing  the  disease. 

LUXATION  OF  RIBS. 

One  of  the  main  objects  of  examination  of  the  thorax  is 
to  locate  misplaced  ribs.  Departures  from  normal  conforma- 
tion of  spine  are  at  once  indications  of  lesion  of  the  several  ribs. 
Hence,  following  the  general  examination  as  outlined  above, 
each  rib  in  particular  must  be  scrutinized.  Landmarks  for  the 
location  of  the  various  ribs  should  be  employed. 

I.  Ribs  are  frequently  separated  or    approximated    beyond 
normal  limits.     These  conditions  are  discovered  by  placing  the 
patient  upon  his  side  and  following  the  successive  intercostal 
spaces  with  the  tip  or  side  of  the  examining  finger.     In  the  latter 
lesion  the  tissues  are  tender  along  the  course  of  the  intercostal 
space,  due  to  irritation  of  the  sensory  branches  of  the  intercostal 
nerves. 

II.  The  same  examination  would  reveal  rotation  of  a  rib 
upon  its  horizontal  axis.     In  such  case  the  intercostal  space  is 
unequally  widened  or  narrowed.     As  a  rule  the  twisting  is  about 
the  head  as  a  fixed  point,  and  the  lower  margin  of  the  rib  is  turned 
out    prominently.     Then    the    intercostal    space   next    below   is 
narrowed  anteriorly  and  widened  posteriorly.     The  anterior  end 
is  tended  downward,  luxating  the  costo-chondral  and  the  chondro- 
sternal  articulations,  as  it  deranges  the  costal  cartilage.     The 
reverse  rotation  of  the  rib  may  take  place,  making  prominent  the 
upper  edge,  throwing  the  anterior  end  upward,  etc. 

III.  By  various  lesions  of  the  ribs,  the  cartilages  are  twisted, 
distorted  or  torn  loose. 

In  such  case  tender  points  are  found  upon  pressure  at  the 
costo-chondal  or  chondro-sternal  articulations.  The  cartilage 
may  be  bulged  forward  by  protrusion  of  the  rib,  causing  a  prom- 
inent tender  point.  It  may  be  retracted,  causing  a  slight  de- 
pression. 

With  the  patient  lying  supine,  the  examining  fingers  may 
be  carefully  passed  over  the  successive  pairs  of  cartilages  and 
these  lesions  be  noted. 


42  PRACTICE    OF    OSTEOPATHY. 

IV.  The  heads  of  ribs  are  often  luxated,  and  may  sometimes 
be  easily  felt  near  the  transverse  process  of  the  adjacent  vertebra. 
This  lesion  is  most  readily  found  by  carefully  feeling  along  the 
shaft  of  the  rib  upward  toward  its  head,  using  deep  pressure.  It 
may  be  impossible  to  trace  the  shaft  by  touch  where  it  is  covered 
by  the  thick  erector  spinae  muscles.  In  such  case  it  is  easy  to 
follow  the  direction  of  the  rib  up  to  the  spine.  Deep  palpation 
may  reveal  the  head  to  be  prominent,  depressed,  or  sore. 

The  FIRST  RIB  is  located  by  deep  pressure  behind  the  mid- 
dle or  inner  one  third  of  the  clavicle.  If  the  latter  has  been  found 
in  situ,  comparison  with  it  may  be  made  to  determine  whether 
the  rib  be  up  or  down.  By  deep  pressure  the  rib  may  be  traced 
well  back  toward  its  head,  which  is  masked  by  the  lateral  cervical 
muscles.  Pressure  may  be  brought  upon  the  head  at  the  level  of 
the  seventh  cervical  spine,  one  and  one-half  inch  laterally  there- 
from. 

This  pressure  is  deeply  in  the  tissues  over  the  region  of 
the  head  of  the  rib.  The  latter  is,  not  always  easily  felt  by  touch, 
but  may  often  be  definitely  felt  out.  Sometimes  the  head  of 
the  first  rib  is  separated  from  and  drawn  outward  away  from  its 
spinal  articulation,  when  it  may  be  easily  felt.  This  sometimes 
occurs  in  cases  of  exophthalmic  goitre.  Dr.  A.  T.  Still  points 
out  that  lesions  of  the  first  rib  often  cause  goitre. 

A  more  reliable  method  for  definitely  locating  the  head  of 
the  first  rib  is  as  follows:  Find  the  tip  of  the  transverse  process 
of  the  seventh  cervical  vertebra,  (XIV,  Chap.  3)  and  make  firm 
downward  pressure  just  in  front  of  it.  As  the  head  of  the  first 
rib  lies  anterior  to  the  transverse  process  of  the  first  dorsal  ver- 
tebra, the  first  bony  part  felt  under  this  pressure  is  the  first  rib 
in  the  region  of  its  head. 

The  sternal  end  of  the  rib  is  located  just  below  the  clavi- 
culo-sternal  articulation.  Its  cartilage  and  shaft  may  be  traced  well 
outward  an  inch  or  more  before  disappearing  beneath  the  clavicle. 

In  case  it  be  luxated  upward,  the  cartilage  is  retracted, 
leaving  a  flat  area  or  a  depression  at  the  cartilage.  If  downward, 
a  protrusion  of  the  cartilage  at  the  edge  of  the  sternum  is  usual. 
In  either  case  the  cartilage  and  the  tissues  about  the  rib  are  sen- 
sitive to  pressure. 


PRACTICE    OF    OSTEOPATHY.  4cf 

The  first  and  second  intercostal  spaces  are  wider  than  the 
others. 

The  SECOND  RIB  is  located  opposite  the  junction  of  the  first 
and  second  parts  of  the  sternum.  Prominence  or  depression 
of  its  cartilage,  and  tenderness  in  the  tissues  about  it  are  caused 
in  the  same  way  as  in  the  case  of  the  first.  Its  head  is  located 
and  pressure  brought  upon  its  region  at  a  point  one  and  one-half 
inches  external  to  the  first  dorsal  spine,  upon  a  level  with  the 
superior  angle  of  the  scapula. 

THE  ELEVENTH  AND  TWELFTH  RIBS  are  more  frequently 
luxated  downwards  because  of  their  anterior  ends  being  un- 
supported and  because  of  traction  upon  the  latter  by  the  quad- 
ratus  lumborum  muscle.  Their  free  ends  are  readily  located 
except  when  irritation  from  them,  or  other  cause,  has  irritated 
the  overlying  muscles,  causing  hypertrophy  or  contracture.  In 
such  case  they  must  be  located  from  the  tenth  rib. 

The  free  end  of  the  eleventh  lies  well  forward,  thus  distin- 
guishing it  from  the  twelfth. 

They  may  be  so  displaced  downward  as  to  be  almost  ver- 
tical; may  overlap  the  iliac  crest,  or  may  be  luxated  upwards, 
the  free  end  of  the  twelfth  lying  beneath  the  eleventh,  or  that 
of  the  eleventh  beneath  the  tenth. 

Frequently  a  luxated  rib  guides  one  to  a  spinal  lesion. 

Displaced  ribs  cause  disease  by  mechanical  interference 
with  internal  viscera,  by  irritation  of  surroundirg  soft  tissues, 
by  dragging  ligaments,  impinging  nerves,  or  occluding  blood- 
vessels. One  must  remember  that  in  probably  most  cases  of 
displacement  of  a  rib  there  is  lesion  at  its  head  affecting  the  re- 
lated spinal  nerves. 


CHAPTER  VII. 
TREATMENT  OF  THORACIC  LESIONS. 

The  thoracic  portion  of  the  spinal  column  is  anatomically 
a  part  of  the  thorax,  but  has  already  been  discussed  under  an- 
other head. 

Osteopathic  treatment  of  the  chorax  is  directed  generally 


44  PRACTICE    OF    OSTEOPATHY. 

to  the  restoration  of  the  ribs  and  other  bony  portions  to  cor- 
rect mechanical  relations.  It  includes  with  this,  work  upon 
ligamentous,  cartilaginous,  and  muscular  lesions,  which  are 
usually  secondary  to  bony  lesion.  Thus  while  osteopathic  treat- 
ment of  the  thorax  consists  largely  in  the  putting  of  ribs  into 
proper  position,  this  work  is  always  done  with  an  eye  to  those 
other  lesions,  and  effects  all  surrounding  tissues;  muscles  and 
ligaments;  nerves  and  vessels;  centers  and  viscera. 

Thoracic  is  inseparable  from  spinal  work,  owing  to  the  in- 
timate anatomical  relations  of  these  parts. 

There  are  various  ways  of  setting  ribs.  Many  of  them  rest 
upon  the  principle  that  the  head  of  the  rib,  being  but  slightly 
movable,  is  the  fixed  point;  that  pressure  upon  the  angles  tends 
to  move  them  about  this  fixed  point;  and  that  this  pressure  may 
be  guided  and  aided  by  elevation  of  the  arm  or  rotation  of  the 
shoulder,  bringing  traction  upon  the  pectoral  and  latissimus 
dorsi  muscles,  etc.,  which  are  attached  to  the  ribs. 

In  some  treatments,  the  sternal  end  is  made  the  fixed  point 
and  the  parts  are  manipulated  accordingly;  in  some,  both  ends 
of  the  rib  are  fixed,  etc. 

Exaggeration  of  lesion,  fixing  of  a  fulcrum,  traction  upon 
attached  tissues,  and  rotation  of  related  parts  are  principles 
applied  to  the  work. 

I.  With  the  patient  sitting  upon  the  side  of  the  table,  the 
practitioner,  standing  in  front,  passes  an  arm  about  the  body 
of  the  patient,  extending  his  hand  past  the  spine  behind,  and 
pressing  with  the  fingers  upon  the  angles  of  the  ribs  of  the  fur- 
ther side.  With  the  other  hand  he  raises  the  patient's  arm  of 
the  side  in  question,  in  front  of  the  body  and  high  over  the  head, 
rotating  it  downward  and  backward.  This  brings  traction  upon 
the  pectoral  muscles  and  soft  tissues  of  the  whole  anterior  aspect 
of  the  side  of  the  chest,  elevates  the  entire  side,  and  effects  par- 
ticularly the  ribs  upon  the  angles  of  which  pressure  is  made.  Care 
must  be  taken  to  maintain  this  pressure  until  the  end  of  the  move- 
ment of  the  arm. 

This  motion  may  be  repeated,  the  pressing  hand  traveling 
down  the  back  to  each  successive  rib  in  need  of  treatment. 


PRACTICE   OF   OSTEOPATHY.  45 

This  treatment  elevates  all  the  ribs  and  tones  all  connected 
muscles,  ligaments,' vessels,  nerves,  etc. 

II.  The  patient  sits  upon  the  stool;  the  practitioner  stands 
behind,  and,  resting  one  foot  upon  the  stool,  makes  a  fixed  point 
of  his  knee  at  the  angle  of  the  rib  under  treatment.     One  hand 
holds  beneath  the  lower  edge  of  the  ribs,  in  front,  while  the  other 
elevates  and  rotates  the  arm  as  in  I,  or  the  first  hand  may  press 
down  upon  the  upper  edge  of  the  rib,  in  front,  while  the  arm  is 
drawn  from  in  front  downwards  to  the  side  of  the  body,  and 
backwards. 

In  these  ways  the  ribs  may  be  forced  downward  or  upward. 

III.  With  the  patient  sitting  or  lying  upon  his  side,  the 
rib  is  thrown  into  action  by  the  patient's  taking  a  full  breath. 
The  operating  hands  are  applied,  one  at  either  end  of  the  rib  in 
question,  and  advantage  is  taken  of  the  relaxation  of  tissues  and 
the  motion  of  the  rib  which  take  place  as  the  patient  expels  the 
breath.     The  whole  rib  is  manipulated  at  this  time  toward  its 
normal  position. 

This  treatment  is  aided  in  some  cases  by  pushing  the  rib 
still  further  from  its  normal  position  before  an  attempt  is  made 
to  restore  it  to  place.  In  this  way  the  principle  of  exaggeration 
of  the  lesion  is  called  into  play. 

IV.  Treatment  II  may  be  applied  with  the  patient  lying 
upon  his  side  instead  of  sitting.     Here  the  practitioner  stands 
behind,  rests  one  foot  upon  the  table,  bending  his  limb  so  as 
to  bring  the  flat  of  his  knee  against  the  angle  of  the  rib.     The 
treatment  then  proceeds  as  in  II.     The  arm  may  be  rotated 
either  forward  and  up,  or  downward  and  back,  pressure  being 
made  at  either  margin  or  at  the  sternal  end  of  the  rib  as  desired. 
This  treatment  allows  the  practitioner  more  latitude  than  does  II. 

Great  caution  must  be  exercised  in  any  application  of  the 
knee  to  the  chest,  either  anteriorly  or  posteriorly.  Active  work 
with  it  should  be  avoided,  use  being  made  of  it  only  as  a  fixed 
point. 

V.  A  fixed  point  may  be  made  of  the  flat  of  the  knee  at  the 
sternal  end  of  the  rib;  the  arm  of  the  patient  upon  the  same  side 
is  manipulated  for  traction  as  before,  while  the  other  operating 
hand  is  passed  over  the  patient's  opposite  shoulder  and  applied 


46  PRACTICE    OF   OSTEOPATHY. 

to  the  spinal  region  of  the  rib.     This  treatment  is  applicable  to 
luxations  of  the  heads  of  ribs.     The  patient  is  sitting. 

VI.  With  the  patient  supine,  the  practitioner  stands  at  one 
side  and  reaches  across  the  patient  to  manipulate  the  ribs  of  the 
opposite  side.     One  hand  is  slipped  beneath  the  back  and  ap- 
plied as  a  fixed  point  to  the  angles  of  any  ribs  in  question;  with 
the  other  hand  the  patient's  arm  is  rotated  as  before  for  traction. 

VII.  With  the  patient  lying  prone,  the  practitioner,  stand- 
ing at  one  side,  reaches  across  the  body  and  makes  a  fixed  poin't 
of  his  elbow  upon  the  angle  of  the  rib.     At  the  same  time  the 
hand  of  the  same  arm  grasps  the  patient's  forearm  upon  that 
side  drawing  it  back  and  up.     Thus,  while  the  rib  is  in  action  the 
pressure  of  the  elbow  forces  the  head  into  place. 

VIII.  With  the  patient  lying  prone,  pressure  with  the  oper- 
ating hands  may  be  brought  vertically  downward  upon  heads  or 
angles  of  ribs,  springing  them  into  place. 

IX.  With  the  patient  lying  supine,  the  practitioner  stands 
a,t  the  side  of  the  table  and  raises  the  patient's  arm  of  the  same 
side  to  a  level  with  the  shoulder.     With  the  arm  thus  horizontal, 
traction  is  made  upon  it,  away  from  the  body,  and  in  such  a 
direction  as  to  bring  longitudinal  tension  upon  the  costal  cartil- 
ages.    The  other  hand  manipulates  the  cartilage  to  reduce  an}' 
twist  or  anterior  prominence  of  it. 

X.  With  the  patient  sitting,  the  practitioner  stands  facing 
him,  making  pressure  with  one  hand  upon  the  sternal  end  of  the 
rib  in  question.     The  other  arm  is  passed  about  the  patient's 
body,  and  the  hand  locates  and  brings  pressure  upon  the  head 
of  the  same  rib.     With  both  ends  of  the  rib  thus  fixed,  the  mo- 
tion of  the  practitioner's  body  is  used  to  rotate  the  patient's 
trunk  about  these  fixed  points,  at  the  same  time  manipulation 
is  directed  to  the  restoration  of  the  rib  to  position. 

It  may  be  said  that,  as  a  rule,  the  setting  of  a  rib  requires 
time  and  patience,  though  in  many  cases  this  may  be  accom- 
plished at  once.  It  is  rarely  the  performance  of  a  set  motion 
that  does  this  work.  On  the  contrary,  the  practitioner,  with 
his  hands  in  position  and  the  parts  under  his  control  as  described 
in  any  particular  treatment,  must  continue  his  efforts,  with  vary- 
ing traction,  pressure,  rotation,  etc.  Movements  of  the  pa- 


PRACTICE    OF    OSTEOPATHY.  47 

tient's  whole  trunk,  bending,  turning,  raising  the  parts,  etc., 
may  all  contribute  to  the  gradual  relaxation  and  yielding  of  the 
parts  to  the  persistent,  well-directed,  and  carefully  judged  efforts 
of  the  Osteopath. 

In  the  case  of  the  FIRST  AND  SECOND  RIBS  many  of  the  gen- 
eral principles  and  treatments,  as  already  described,  may  be 
applied.  Special  methods,  however,  are  generally  necessary 
to  replace  them.  As  already  stated,  these  ribs  are  usually  lux- 
ated upwards,  but  may,  as  well,  be  displaced  downwards. 

I.  UPWARD  DISPLACEMENTS. 

(1)  The    scaleni    muscles    are    first    relaxed    and    stretched 
(Chap.  IV,  div.  XI),  the  head  is  now  bent  toward  the  shoulder 
of  the    affected  side,  and  pressure  is  brought  directly  downward 
upon  the  upper  margin,  the  sternal  or  spinal  end  of  either  or 
both  ribs  (Chap.  VI).     In  this  way,  either  rib  may  be  lowered 
as  a  whole  or  at  either  end. 

(2)  With  the  patient  lying  upon  his  back,  the  practitioner 
stands  at  the  head  of  the  table;  presses  the  palm  of  the  thumb 
down  upon  the  upper  margin  of  the  first  rib;  with  the  other  hand 
he  raises  the  arm  of  the  patient  upon  the  side  in  question,  and 
pushes  it  across  the  chest  at  the  level  of  the  shoulder,  thus  re- 
laxing the  tissues  at  the  side  of  the  neck,  and  elevating  the  clavicle 
so  that  the  thumb  may  be  thrust  more  deeply  behind  it.     Pres- 
sure may  be  applied  anywhere  along  the  upper  margin  of  the  rib, 
lowering  it  to  its  normal  position. 

(3)  A  most  effective  treatment  is  shown  by  Dr.  Still.     For 
example  if  the  lesion  be  to  the  right  rib,  the  patient  is  to  sit  side- 
wise  upon  the  table.     The  practitioner  sits  beside  him,  at  his 
left,  passing  his  right  arm  under  the  left  axilla  and  placing  his 
right  fingers  on  the  upper  aspect  of  the  rib.     His  left  hand  is 
pressed  against  the  patient's  head.     First  the  patient's  head  is. 
drawn  toward  the  practitioner  while  his  body  is  pushed  slightly 
away.     This  swerves  the  spinal  column  and  throws  the  luxated 
rib  up  higher,  exaggerating  the  lesion.     Now  the  head  is  pushed 
well  away  from  the  practitioner,  while  the  body  is  drawn  to  him, 
with  accompanying  strong  pressure  of  the  right  hand  downward 
upon  the  shaft  of  the  first  rib,  which  is  thus  replaced. 


48  PRACTICE    OF    OSTEOPATHY. 

II.  DOWNWARD  DISPLACEMENTS. 

(1)  With  the  patient   sitting,   the  practitioner  stands   be- 
hind and  brings  pressure  with  his  fingers  upon  the  inferior  mar- 
gin of  the  first  or  second  rib.     At  the  same  time  the  head  is  bent 
to  the  opposite  side,  bringing  traction  upon  the  rib  through  the 
scaleni  muscles,  and  rotated  backward.     This  rotation  tends  to 
bring  more  traction  upon  the  anterior  end  through  the  scalenus 
anticus  (in  case  of  the  first  rib.)     The  treatment  may  be  used  to 
elevate  either  rib. 

(2)  The  treatment  as  described  under  II  and  IV  of  this 
chapter  may  be  used. 

(3)  With  the  patient  sitting  and  the  practitioner  standing 
in  front,  pressure  may  be  made  by  the  fingers  below  the  region 
of  the  heads  of  the  first  and  second  rib,  (see  Cap.  VI),  while  the 
head  is  bent  to  the  opposite  side  and  rotated  forward.     This 
rotation  tends  to  bring  more  traction  upon  the  posterior  ends  of 
the  first  and  second  ribs  through  increased  traction  respectively 
of  the  scalenus  medius  and  scalenus  posticus  muscles. 

(4)  In   case   of  anterior  protrusion   of   the   cartilages    (see 
Chap.  VI),  pressure  may  be  brought  upon  them  while  treatment 
(I)  above  is  being  given. 

Or  the  patient's  arm  is  raised  to  the  level  of  his  shoulder 
and  drawn  backwards,  bringing  traction  upon  the  cartilages, 
while  pressure  is  applied  to  them. 

The  first  two  ribs  may  be  separated,  as  follows:  The  pa- 
tient lies  supine  and  a  hand  is  slipped  beneath  his  shoulder, 
bent  to  form  a  fulcrum  beneath  the  two  ribs;  the  patient's  arm 
is  grasped  at  the  elbow,  raised,  and  bent  strongly  across  the 
anterior  chest  at  the  level  of  the  shoulder.  This  tends  to  drive 
the  two  ribs  sternum-ward,  and  to  separate  them  anteriorly 
owing  to  the  intercostal  space  being  wider  at  its  anterior  end 
than  at  the  other. 

THE  ELEVENTH  AND  TWELFTH  RIBS. 
A.  DOWNWARD  DISPLACEMENTS. 

A  preliminary  step  must  be  taken  in  the  relaxation  of  all 
muscles  and  tissues  about  the  ribs,  especially  of  the  quadrati 


PRACTICE    OF    OSTEOPATHY.  49 

lumborum  muscles.  This  is  easily  accomplished  by  manipu- 
lation of  the  tissues.  A  special  method  of  stretching  the  quad- 
rati  is  as  follows:  The  patient  lies  upon  his  side  and  the  prac- 
titioner stands  in  front.  He  grasps  the  arm  of  the  patient  and 
draws  it  diagonally  forward,  at  the  level  of  the  shoulder,  in  a 
direction  away  from  the  pelvis.  At  the  same  time  his  other 
hand  makes  pressure  upon  the  anterior  iliac  crest  in  a  direc- 
tion diagonally  backward,  i.  e.,  in  a  direction  exactly  the  op- 
posite from  that  in  which  the  arm  is  drawn.  This  stretches 
the  muscles  diagonally  and  rotates  the  lumbar  portion  of  the 
spine,  The  motion  is  now  reversed  by  standing  in  front  of  the 
pelvis,  grasping  the  crest  of  the  ilium,  and  drawing  it  diagonally 
forward  in  a  direction  away  from  the  shoulder.  At  the  same 
time  the  other  hand  holds  the  bent  arm  rigid  at  the  side  and 
pushes  it  in  a  direction  opposite  from  that  of  the  traction  applied 
to  the  pelvis.  This  motion  gives  the  opposite  diagonal  stretch 
to  the  quadratus  lumborum,  and  rotates  the  lumbar  region  of 
the  spine. 

The  eleventh  or  twelfth  rib  itself  is  readily  manipulated 
upward  or  downward  by  taking  advantage  of  three  points;  (1) 
The  head  usually  remains  a  fixed  point,  (2)  Pressure  made  upon 
the  outer  aspect  of  the  rib  in  the  region  of  its  angle  (or  turn  in 
case  of  the  twelfth,  which  lacks  the  angle)  may  be  so  directed  as 
to  move  or  rotate  the  rib  upward  or  downward  about  the  fixed 
point,  (3)  The  free  end  may  be  readily  moved  upward  or  down- 
ward by  the  pressure  of  a  finger,  and  this  pressure,  combined 
with  pressure  in  the  opposite  direction  applied  at  the  angle,  readi- 
ly rotates  the  rib  about  its  horizontal  axis. 

One  hand  easily  spans  the  rib,  leaving  the  other  hand  free 
to  manipulate  the  body  and  aid  the  operation.  The  thumb  is 
pressed  against  the  free  end  of  the  rib  and  forces  it  upward  or 
downward,  while  the  fingers  of  the  same  hand  bring  pressure 
in  the  opposite  direction  at  the  angle  of  the  rib.  In  this  way 
the  rib  is  rotated  about  the  head  as  a  fixed  point  and  may  be 
raised  or  lowered  as  desired. 

I.  With  the  patient  lying  upon  his  side,  his  knees  flexed 
and  supported  against  the  abdomen  of  the  practitioner,  the 
operating  hand  manipulates  the  rib  as  above  described,  forcing 


50  PRACTICE    OF    OSTEOPATHY. 

it  upward.  At  the  same  time  the  free  arm  has  grasped  the 
semi-flexed  limbs,  raised  them  slightly  to  rotate  the  pelvis  and 
lower  lumbar  spine,  and  thrusts  them  downward  in  extension 
to  stretch  the  soft  tissues  and  aid  in  increasing  the  distance  be- 
tween ribs  and  pelvis. 

II.  This  movement  may  be  varied,  grasping  the  limbs  in 
the  same  way  and  drawing  them  and  the  pelvis  over  the  side 
of  the  table,  rotating  them  downward  about  the  edge  of  the 
table,  extending  the  limbs  and  rotating  them  upward  and  onto 
the  table.     The  rib  is  manipulated  as  in  I.     This  is  a  strong 
treatment,  and  applies  great  force  to  the  rib. 

III.  With  the  patient  sitting,  a  hand  is  applied  to  each  end 
of  the  rib.     The  patient  takes  a  full  breath  to  throw  the  rib  into 
activity;  pressure  is  so  applied  as  to  exaggerate  the  lesion,  and 
the  rib  is  finally  pressed  upward  to  its  normal  position  as  the 
patient  exhales. 

IV.  The   patient   lies   upon   his   side;   one   operating   hand 
grasps  the  ilio-costal  tissues  and  draws  them  diagonally  down- 
ward and  forward  in  the  direction  in  which  the  rib  points.     The 
other  hand  is  placed  upon  the  angle  of  the  rib  and  pushes  it  in 
the  same  direction.     In  this  way  the  tissues  are  stretched  and 
the  lesion  exaggerated.     The  motion  is  finished  by  an  upward 
turn  of  the  hands,  the  former  pressing  the  end  of  the  rib  upward, 
the  latter  forcing  the  shaft  of  the  rib  upward. 

B.  UPWARD  DISPLACEMENTS. 

In  these  cases  the  anterior  ends  of  the  ribs  are  upward  under 
the  rib  above.  All  tissues  are  first  relaxed  as  before,  and  the 
free  end  is  located  by  deep  pressure  beneath  the  ribs  and  tissues. 
The  rib  may  be  manipulated  as  before  described. 

Treatments  I,  II  and  III  may  be  applied  equally  as  well  to 
the  reduction  of  upward  displacements;  the  appropriate  pres- 
sure being  made  to  force  the  rib  downward. 

The  STERNUM,  if  PROTRUDED  or  RETRACTED  as  a  whole,  is 
restored  to  normal  through  the  general  shaping  of  the  thorax 
l&y  methods  already  described.  The  ensiform  appendix,  being 
cartilaginous,  is  usually  easily  sprung  by  pressure  and  trained 
toward  its  normal  position. 


PRACTICE    OF   OSTEOPATHY.  51 

In  case  of  luxation  between  the  first  and  second  parts  of  the 
sternum,  traction  is  brought  upon  the  first  part  through  the 
deep  .cervical  tissues  and  the  sterno-mastoid  muscle  of  either 
side  by  rotation  of  the  head  backward  and  to  one  side.  At  the 
same  time  pressure  is  made  upon  the  prominent  end  of  the  first 
or  second  part,  reducing  it. 

The  CLAVICLE  may  be  restored  from  any  of  its  usual  mal- 
positions as  follows:  The  patient  lies  supine  and  the  practi- 
tioner stands  at  the  head  of  the  table,  slightly  to  one  side,  the 
fingers  of  the  operating  hand  are  pressed,  palm  up,  behind  the 
clavicle,  the  tissues  being  relaxed  by  slightly  raising  the  shoulder. 
The  free  hand  now  grasps  the  arm  of  the  patient  just  above  the 
elbow  and  pushes  the  bent  arm  across  the  chest,  up  over  the  face, 
above  the  head,  and  rotates  it  down  to  the  side  again.  This 
motion  has  raised  the  clavicle  and  allowed  the  fingers  to  be  pressed 
deeply  behind  it.  They  may  be  applied  particularly  to  the 
sternal  end.  The  elevation  of  the  shoulder  has  widened  the 
anterior  end  of  the  costo-clavicular  space  and  allowed  the  fingers 
to  be  brought  well  forward  toward  the  sternal  end.  As  the  arm 
is  now  rotated  outward,  the  increase  of  distance  between  the 
sternal  and  acromial  attachments  of  the  bone  draws  it  down 
hard  upon  the  fingers  between  it  and  the  rib,  forcing  it  upward 
from  either  an  anterior  or  posterior  downward  dislocation. 

In  case  the  sternal  end  has  been  dislocated  upward  on  the 
sternum,  the  motion  would  have  been  the  same,  except  that 
during  the  outward  rotation  of  the  arm,  pressure  would  have 
been  made  above  the  sternal  end  to  force  it  downward. 

In  case  the  acromial  end  had  been  downward  or  upward  the 
same  motion  would  be  applied,  with  the  operating  hand  di- 
rected to  that  end  of  the  bone.  During  the  outward  rotation 
of  the  arm  the  bone  would  be  grasped  between  the  fingers  behind 
and  the  thumb  in  front  and  moved  upward  or  downward  from 
its  displacement. 

Here,  as  in  case  of  the  ribs,  it  is  less  probable  that  the  per- 
formance of  a  single  set  motion  would  accomplish  the  work  than 
that  insistent,  though  not  violent,  traction,  pressure,  rotation, 
etc.,  according  to  the  manner  of  the  described  treatment,  would 
secure  the  result. 


52  PRACTICE   OF   OSTEOPATHY. 

The  posterior  margin  of  the  clavicle  may  be  tipped  up- 
ward, so  that  the  space  between  its  outer  end  and  the  scapula 
is  widened.  The  tissues  at  this  point  are  then  tender.  The 
condition  may  be  remedied  by  the  proper  application  of  the 
above  treatment  for  reduction  of  displacement  of  the  acromial 
end. 


CHAPTER  VIII. 

GENERAL  OSTEOPATHIC  POINTS  IN  REGARD  TO  THE  ABDOMEN 
AND  ITS  PARTS. 

Many  of  the  specific  lesions  affecting  thfe  abdomen  and  its 
contained  viscera  occur  in  the  spine  and  thorax  and  are  of  kinds 
already  described.  Much  of  the  treatment  for  diseases  of  these 
parts  is  upon  such  lesions.  The  subject  of  examination  and 
treatment  of  the  various  organs  will  be  considered  more  in  de- 
tail in  relation  to  their  specific  diseases.  The  aim  of  this  chapter 
is  to  give  general  methods  of  examination  and  general  osteopathic 
points  concerning  these'  parts. 

POSITION:  The  patient  lies  supine;  the  thighs  are  flexed 
and  the  feet  rest  upon  the  table;  the  head  and  chest  are  slightly 
elevated  by  the  inclined  head  of  the  table.  In  this  position  the 
abdominal  muscles  are  relaxed.  The  sides  of  the  body  are  dis- 
posed alike  to  avoid  unequal  tension  upon  the  tissues. 

Inspection,  palpation,  percussion  and  auscultation  are  the 
physical  methods  employed. 

INSPECTION  reveals  enlargement  due  to  gas  or  fluid,  tumor, 
muscular  contraction,  etc.;  color;  distended  or  retracted  walls: 
restricted  or  increased  motion;  pulsation  or  engorgement  of 
blood-vessels,  etc. 

PALPATION  reveals  change  in  temperature:  tumors,  super- 
ficial or  deep,  fluid  or  solid;  tenseness  or  flabbiness  of  the  ab- 
dominal walls;  enlargements  and  displacements  of  organs,  etc. 
Pulsations,  also,  are  to  be  noted.  A  marked  pulsation  of  the 
abdominal  aorta  is  common  in  nervous  people,  but  generally 
indicates  liver,  stomach,  or  intestinal  congestions. 


PRACTICE    OF    OSTEOPATHY.  53 

Deep  palpation  of  the  abdomen  in  thin  persons  readily  reaches 
the  bodies  of  the  lumbar  vertebrse,  rising  quite  prominently 
under  the  touch.  They  should  not  be  mistaken  for  tumor. 

The  examiner  should  grasp  the  abdominal  walls  in  the  fingers 
and  raise  them  up  away  from  the  abdominal  viscera,  thus  en- 
abling him  to  tell  whether  tender  places,  growths,  etc.,  lie  in  or 
beneath  these  walls. 

PERCUSSION  reveals  the  limits  of  organs,  presence  of  tu- 
mors, fluids  or  gases,  etc. 

AUSCULTATION  reveals  the  gurgling  of  gases,  fetal  sounds, 
lubrication  of  the  bowel,  etc. 

I.  A  general  treatment  of  the  abdomen  is  sometimes  nec- 
essary for  general  relaxation  of  the  abdominal  walls,  often  as 
a  preliminary  step  toward  further  examination.     With  the  pa- 
tient in  position  as  above,  the  practitioner  stands  at  the  side  of 
the  table  and  with  the  palm  of  the  hand  manipulates  the  tissues 
to  relax  them.     Care  should  be  taken  to  avoid  pressure  with  the 
tips  of  the  fingers  or  other  rude  work  which  causes  the  tissues 
to  contract.     The  hand  should  be  warm  and  the  manipulation 
gentle  but  thorough. 

II.  Direct    manipulation,    including    pressure    and    various 
movements,  is  often  made  upon  the  various  abdominal  organs. 
Specific  directions  for  the  treatment  of  any  given  organ  are  re- 
served until  diseases  of  these  organs  are  considered.     But,  speak- 
ing in  general  of  abdominal  manipulation  as  one  of  the  methods 
in  the  repertoire  of  the  Osteopath,  care  must  be  taken  to  make 
clear  the  difference  between  such  manipulation  and   massage. 
Here  the  mode  of  motion  is  relatively  insignificant.     The  manip- 
ulation is  not  for  the  general  effect  following  a  thorough  abdominal 
massage,  but  is  corrective ;  directed  to  the  specific  end  of  restoring 
to  proper  mechanical  relations  an   organ   or  organs  definitely 
ascertained  to  be  in  need  of  mechanical  adjustment.     Here,  as 
elsewhere  in  the  body,  this  work  removes  pressure  from,  or  in- 
terference with,  blood-vessels  and  nerves.     For  example,  osteo- 
pathic  treatment  of  the  colon  is  not  made  for  general  manipula- 
tive effect,  but  is  directed  to  raising  and  straightening  a  sigmoid 
too  much  bent  or  folded.     Thus  it  removes  a  mechanical  ob- 


54  PRACTICE    OF    OSTEOPATHY. 

struction  to  bowel  action,  but  also  lets  free  pelvic  circulation  and 
nerve-action  impeded  by  such  a  condition. 

Or,  manipulation  of  the  colon  raises  from  its  unnatural  po- 
sition the  gut  which  has  prolapsed  and  become  wedged  down 
among  the  pelvic  viscera,  where  it  has  destroyed  harmony  of 
the  functions.  Osteopathic  manipulation  in  this  way  is  specific 
and  corrective,  based  upon  mechanical  principles,  and  is  applied 
by  a  practitioner  who  knows  what  causes  such  abdominal  condi- 
tions and  how  to  correct  them. 

III.  With  the  patient  in  position  as  above,  or  standing  or 
sitting  bent  well  forward,   the  fingers  are  inserted  deeply  be- 
neath the  viscera  in  each  iliac  fossa.     They  are  now  drawn  di- 
rectly  upward,   raising   all   the   pelvic   and   abdominal   viscera, 
freeing  the  action  of  the  femoral  and  pelvic  vessels  and  nerves. 

In  case  the  patient  has  bent  forward  he  straightens  the 
body  again  at  the  time  the  viscera  are  raised. 

IV.  With  the  patient  lying  upon  the  right  side,  the  prac- 
titioner stands  behind  the  pelvis  and  presses  the  fingers  deeply 
into  the  iliac  fossa  upon  the  side  of  the  sigmoid  nearest  the  median 
plane  of  the  body.     He  now  raises  the  sigmoid  flexure  upward 
and  slightly  outward  over  the  flaring  inner  surface  of  the  ilium. 
This  raises  the  gut  from  the  pelvis,  relieves  kinking,  and  frees 
the  circulation  of  the  part. 

The  movement  may  be  repeated  for  the  caecum. 

The  knee-chest  position  is  very  important  and  effective  in 
all  conditions  requiring  the  elevation  of  pelvic  and  abdominal 
viscera.  The  patient  gets  upon  his  knees,  and,  turning  his  head 
to  one  side,  lays  the  upper  part  of  the  chest  upon  the  table  (still 
remaining  on  his  knees.)  While  he  is  in  this  position  manipula- 
tions are  made  to  draw  abdominal  and  pelvic  contents  down 
away  from  the  pelvis.  Gravitation  aids  this  process. 

V.  With  the  patient  in  the  dorsal  position,  the  practitioner 
stands  at  the  side  and  places  the  palms  of  the  hands  over  the 
false  ribs  and  cartilages,  one  on  either  side,  heel  out  and  fingers 
directed  toward  toward  the  median  plane  of  the  body.     Pres- 
sure is  now  made  evenly  upon  the  sides,  springing  the  ribs  and 
cartilages  down  upon  the  viscera  beneath.     As  the  pressure  is 
directed  inward  the  ribs  are  forced  toward  the  mid-line  and  pressed 


PRACTICE    OF    OSTEOPATHY.  55 

down  u'pon  the  viscera.  Repeating  this  motion  at  intervals  of 
a  few  seconds  thoroughly  tones  the  nerve-plexuses  and  blood- 
flow  of  the  upper  abdominal  viscera. 

VI.  Deep  pressure  is  made  upon  the  solar  plexus  as  follows: 
The  patient  lies  supine,  the  practitioner  stands  at  the  side  and 
lays  the  palmar  surface  of  the  distal  phalanges  of  one  hand  over 
the  pit  of  the  stomach,  at  the  level  of  the  tips  of  the  seventh 
and  eighth  ribs.     Pressure  with  the  second  hand  upon  the  first 
is  gradually  applied,  the  hand  sinking  deeper  into  the  tissues 
until  very  deep  pressure  has  been  made.     The  plexus  may  now 
be   manipulated   by   a   slight   circular  movement   of  the   hand. 
This  treatment  tones  the  action  of  the  solar  plexus,   etc.     It 
should  be  gently  and  gradually  applied,  but  the  pressure  must 
be  considerable. 

VII.  Deep  pressure  as  above  at  any  point  will  cause  a 
purely  nervous  pain  to  lessen  or  disappear,  while  it  increases 
a  pain  due  to  inflammation. 

VIII.  Displaced   ribs  sometimes  mechanically  depress  vis- 
cera, and  must  then  be  replaced  by  methods  already  described. 

IX.  The   fundus   of   the   gall-bladder   is   reached   by   deep 
pressure  beneath  the  tip  of  the  ninth  rib  on  the  right  side.  Thence 
the  course  of  the  bile  duct  to  the  duodenum  is  somewhat  in  the 
shape  of  a  reversed  "S,"  opening  into  the  duodenum  from  one 
to  two  inches  below  the  umbilicus.     Manipulation  aids  in  empty- 
ing the  bladder  and  in  passing  gall-stones  along  the  duct. 

Abdominal  treatment  is  generally  in  conjunction  with 
treatment  upon  the  specific  lesion  occurring  in  the  spine,  thorax, 
etc.  It  must  be  given  carefully,  as  there  are  many  diseases,  e.  g., 
typhoid,  in  which  rough  abdominal  treatment  might  cause  seri- 
ous injury.  It  is  directed  to  a  specific  end  and  restores  mechani- 
cal relations  of  parts,  frees  nerve  and  blood-mechanisms,  removes 
muscular  contracture,  etc. 


56  PRACTICE    OF    OSTEOPATHY. 

CHAPTER  IX. 

EXAMINATION  AND  TREATMENT  OF  LESIONS  OF  THE  PELVIS. 

The  importance  of  pelvic  lesion  can  scarcely  be  overestimated 
on  account  of  its  relations  to  the  spine  above,  to  its  contained 
viscera,  and  to  the  lower  portions  of  the  body.  This  chapter 
does  not  deal  with  diseases  of  the  pelvic  organs,  but  with  bony 
and  ligamentous  lesions  of  the  pelvis  which  are  so  significant, 
from  the  osteopathic  standpoint,  as  causes  of  disease  in  the  pelvic 
viscera,  in  the  limbs,  or  in  the  body  above. 

A.  LESIONS  AFFECTING  THE  PELVIS  AS  A  WHOLE: 

I.  EXAMINATION.  The  examiner  must  not  neglect  to  ex- 
amine the  spine  in  relation  to  pelvic  lesion,  as  malpositions  of 
this  structure  are  almost  sure  to  destroy  spinal  equilibrium 
and  thus  to  affect  spinal  relations,  sometimes  to  a  serious  extent 
The  most  common  of  such  results  is  swerving  or  curvature  of  the 
spine  in  response  to  the  efforts  of  nature  to  adapt  the  spine  to  a 
crooked  pelvis. 

The  pelvis  as  a  whole  may  be  tipped  forward  or  backward; 
may  be  turned  to  either  side ;  or  may  be  tilted,  throwing  one  crest 
up  and  the  other  downward.  These  malpositions  may  be  com- 
bined in  various  ways.  The  general  symptoms  of  such  trouble 
are  pelvic  diseases,  female  disorders,  backache,  neck  lesion, 
sciatica,  lameness  or  paralysis  of  the  lower  limbs,  etc.  In  case  of 
lesion  of  the  whole  pelvis,  the  point  of  movement  upon  the  spine 
is  usually  the  lumbo-sacral  articulation,  but  the  fifth  lumbar 
vertebra  may  be  carried  with  the  pelvis,  or  the  yielding  point 
may  include  the  whole  lumbar  region. 

INSPECTION  AND  PALPATION  aid  each  other  in  the  examina- 
tion. 

(1)  Both   superior   posterior   iliac   spines  are   found   equally 
too  prominent  in  case  of  backward  luxation  of  the  pelvis,  or 

(2)  They  are  alike  found  to  have  receded  anteriorly  in  for- 
ward luxation,  or 

(3)  One  is  prominent  and  the  other  has  receded  anteriorly  in 
twisting  of  the  pelvis  sidewise,  or 

(4)  One  stands  higher  than  the  other  in  case  of  tilting  of 


PRACTICE    OF   OSTEOPATHY.  57 

the  pelvis  laterally.  In  the  latter  case,  comparision  shows  in- 
equality in  the  length  of  the  limbs,  and  tenderness  is  often  found  in 
the  tissues  upon  the  iliac  crest  of  the  low  side  owing  to  greater 
tension  upon  them.  At  the  same  time  the  waist  line  is  deepened 
upon  the  high  side  and  filled  out  upon  the  low  side. 

Examination  and  comparison  of  the  posterior  superior 
spines  is  best  made  upon  the  bared  back,  with  the  patient  sit- 
ting sidewise  upon  the  table.  The  practitioner  sits  upon  a  low 
stool  directly  behind  the  patient,  placing  a  hand  upon  each  spine, 
examining  and  comparing  them  carefully.  Care  must  be  taken 
that  careless  posture  of  the  patient  does  not  cause  an  apparent 
inequality,  or,  on  the  other  hand,  that  an  assumed  position  does 
not  mask  the  lesion. 

With  the  patient  sitting  or  lying  on  the  side,  careful  pal- 
pation is  made  of  the  superficial  and  deep  soft  tissues  in  the 
•sacro-iliac  and  posterior  sacral  regions.  These  are  commonly 
.sensitive  to  pressure,  but  are  always  tensed,  congested  and 
•strained  over  the  sacro-iliac  articulation  and  the  posterior  sacral 
foramina.  These  ligamentous  lesions  alone  cause  much  ill  by 
obstructing  nerve-action.  The  hand  is  also  passed  along  the 
crests  of  the  ilia,  making  deep  pressure  in  the  tissues,  to  discover 
tenderness  in  them. 

Tilting  of  the  pelvis  may  be  ascertained  by  having  the  pa- 
tient hold  the  tape  between  his  teeth  in  the  mid-line  of  the  body, 
from  which  point  measurement  is  made  to  the  inner  malleolus 
•of  the  tibia  on  each  side.  Tilting  of  the  pelvis  cannot  be  ascer- 
tained by  measurements  unless  a  fixed  point  above  the  pelvis 
is  used  as  the  starting  point. 

II.  TREATMENT. 

In  the  treatment  of  all  the  lesions  above  described,  a  pre- 
liminary step  may  usually  be  made  with  advantage  by  thor- 
ough relaxation  of  the  soft  tissues  in  the  sacro-iliac  regions  as 
already  described.  (Chap.  II,  divs.  Ill,  XIII,  XIV,  XIX.) 

All  the  lesions  described  may  be  treated  with  the  patient 
sitting  upon  the  stool,  his  pelvis  fixed  by  an  assistant,  who  stands 
in  front  or  behind  and  grasps  the  iliac  crests,  one  with  each  hand. 

(1)  For  backward  tipping,  the  assistant  stands  in  front  and 


58  PRACTICE    OF    OSTEOPATHY. 

draws  the  pelvis  forward,  while  the  practitioner  stands  behind r 
grasps  the  patient  beneath  the  axillae,  and  raises  and  draws  the 
trunk  backward.  His  work  is  aided  by  pressure  of  his  knee 
against  the  sacrum.  During  this  treatment,  slight  rotation  of 
the  body  from  one  side  to  the  other  during  the  lifting  process 
helps  the  reduction  of  the  lesion. 

(2)  For  tilting  upward  on  one  side  or  for  turning  to  either  side, 
this  same  treatment  may  be  applied  -with  variations  to  suit  the 
condition. 

(3)  For  tipping  forward,   the  assistant  stands  behind   and 
draws  the  pelvis  backward,  while  the  practitioner  manipulates 
the  trunk  from  in  front,  in  a  similar  manner  as  before,  grad- 
ually working  and  drawing  it  forward. 

(4)  For  tipping  forward,  the  patient  may  lie  upon  his  side, 
the  practitioner  stands  behind  the  pelvis,  making  a  fixed  point 
with  one  palm  against  the  lower  portions  of  the  innominates 
and  sacrum.     He  now  draws  backward,  with  the  other  hand, 
upon  the  uppermost  iliac  crest  and  anterior  superior  spine.     The 
patient  lies  upon  the  other  side  and  the  motion  is  repeated. 

(5)  For  tipping  backward,   the  patient  lies  upon  his  side, 
the  practitioner  stands  behind  and  presses  the  flat  of  his  knee 
against  the  upper  portion  of  the  sacrum.     He  now  grasps  the 
uppermost  limb  with  one  hand,  the  uppermost  shoulder  with 
the  other,  and  draws  the  body  backward,  while  forcing  the  pelvis 
carefully  forward. 

(6)  For  tilting  upward  of  the  pelvis,  one  may  adapt  to  the 
reduction  of  this  lesion  the  treatment  described  in  Chap.  VII, 
A,  Downward  Displacements  of  Lower  Ribs,  for  the  stretching 
of  the  quadrati  lumborum  muscles. 

(7)  For  turning  of  the  pelvis  to  one  side,  one  may  adapt  to 
the  reduction  of  this  lesion  the  treatment  as  described  in  Chap. 
II,  div.  XVIII,  third  treatment. 

B.  LESIONS  AFFECTING  PARTS  OF  THE  PELVIS. 

We  deal  here  chiefly  with  lesions  of  the  innominate  bones. 
They  are  more  frequent  than  lesions  of  the  pelvis  as  a  whole, 
and  are  relatively  more  important. 

The  general  indications  of  innominate  lesion,  which  would 
lead  one  to  examine  for  such  displacement,  are  back-ache,  sciatica, . 


PRACTICE   OF   OSTEOPATHY.  59 

pain  or  lameness  in  the  limbs,  limping  or  unequal  gait,  pelvic 
disease,  female  disorders,  etc. 

The  lesions  of  the  innominate  commonly  met  with  are: 

I.  The  innominate  displaced  forward  or  backward. 

II.  The  innominate  displaced  upward  or  downward. 

III.  Combinations  of  the  above,  which  are  the  rule.     It  is 
rare  that  the  simple  lesion  I  or  II  is  found.     Frequently  the 
displacement  is  downward  and  backward  at  the  same  time,  lentgh- 
ening  the  leg.     This  lesion  is,  on  the  whole,  the  most  common 
but   the   opposite   luxation,   forward   and   upward,   is   frequent. 
Generally  if  the  lesion  is  backward,  it  is  at  the  same  time  down- 
ward; if  it  is  forward,  it  is  at  the  same  time  upward.     In  the 
latter  case,  the  leg  is  shortened.     Yet  it  cannot  be  stated  as  the 
invariable  rule  that  the  backward  lesion  is  combined  with  the 
downward  one,  and  that  the  upward  and  forward  positions  always 
combine.     The  luxation   may   be  back   and  up,   or  vice-versa. 
Yet,  whatever  the  combined  lesion  be,  a  lengthened  limb  indi- 
cates a  downward  displacement  of  the  innominate,  while  a  short- 
ejied  limb  shows  the  reverse. 

There  are  numerous  points  upon  the  lateral  articular  surface 
of  the  sacrum,  any  one  of  which  may  act  as  the  fixed  point  about 
which  ,the  innominate  bone  may  rotate.  This  fixed  point  may 
be  termed  the  axis  of  rotation,  and  its  location  determines  how 
the  innominate  rotates,  and  whether  the  leg  be  lengthened  or 
shortened  as  a  result  of  the  lesion.  Thus,  if  the  axis  of  rotation 
be  located  upon  the  upper  and  anterior  part  of  the  auricular  sur- 
face of  the  sacrum,  the  innominate  may  rotate  forward,  while 
at  the  same  time  the  posterior  superior  spine  is  thrown  upward 
and  the  leg  is  lengthened. 

The  reason  why  the  downward  lesion  usually  complicates 
the  backward  one  is  found  in  the  beveled  edge  of  the  sacrum 
where  it  articulates  with  the  ilium.  This  bevel  is  wedge-shaped 
with  its  broad  end  up.  Moreover,  its  posterior  margin  is  longer, 
and  rises  higher  than  its  anterior  edge.  Thus  the  beveled  auri- 
cular surface  of  the  sacrum,  which  bone  is  broader  in  front  and 
tilts  forward  so  that  the  posterior  margin  of  its  base  stands  higher, 
directs  the  ilium  either  downward  and  backward,  or  upward  and 


60  PRACTICE    OF    OSTEOPATHY. 

forward,  according  to  the  direction  of  the  forces  causing  the 
lesion 

IV.  Each  innominate  may  suffer  from  lesion  at  the  same 
time,  which  ma}-  be  alike  upon  both  sides,  or  different. 

EXAMINATION:  PALPATION,  aided  by  INSPECTION,  is  used 
in  the  examination. 

I.  The  length  of  the  limbs  is  compared,  and  is  one  of  the  first 
and  most  reliable  methods  of  examining  for  lesion  of  the  innom- 
inate.    The  patient  is  laid  upon  his  back;  care  is  taken  that  he 
shall  lie  perfectly  straight;  the  limbs  are  flexed  and  rotated  to 
relax   muscles   and   ligaments,    and   to   prevent   any   unnatural 
tension  in  these  structures  from  causing  merely  apparent  differ- 
ence in  length.     The  limbs  are  now  drawn  down  and  compared 
at  the  heels.     It  is  best  to  have  the  patient  keep  the  shoes  on, 
but  care  must  be  taken  to  notice  that  the  heels  of  the  shoes  do 
not  differ  in  thickness,  and  that  they  are  pushed  back  snugly 
against  the  patient's  heel. 

This  examination  is  for  confirmation  only,  and  while  it  is 
a  clear  indication,  that  one  innominate  is  luxated,  further  ex- 
amination is  necessary  to  determine  whether  one  leg  is  too  long, 
or  the  other  too  short,  or  both. 

II.  Tenderness  in  the  sacro-iliac  ligaments  upon  deep  pres- 
sure, and  tenderness  in  the  tissues  along  the  crest  of  the  ilium  indi- 
cate that  the  lesion  is  upon  the  side  upon  which  such  tenderness 
occurs.     The   sacro-iliac  ligaments  are  found  tensed  upon  the 
side  of  lesion. 

While  this  tenderness  and  tension  will  usually  indicate  uni- 
lateral lesion,  it  is  not  an  invariable  sign,  as  the  strain  thrown 
upon  the  opposite  side  often  causes  like  effects. 

Tenderness  at  the  pubic  symphysis  is  often  present  in  these 
cases. 

III.  The  position  of  the  posterior  superior  iliac  spines  is  the 
best  indication  of  lesion,  receding  anteriorly,  prominent  poster- 
iorly, up,  or  down,  down  and  back,  forward  and  up.  etc.,  indi- 
cating the  corresponding  malposition  in  the  bone.     Comparison 
of  the  spine  of  the  luxated  bone  with  that  of  the  normal  bone  is 
made.     This  examination  must  be  made  upon  the  bared  back 
with  the  patient  sitting.     The  practitioner  sits  directly  behind 


PRACTICE   OF   OSTEOPATHY.  61 

i 

the  patient,  palpation  of  both  spines  alike  is  made  at  the  same 
time,  one  hand  upon  each.     This  facilitates  comparison. 

IV.  The    waist-line    is    frequently    changed    in    each    case. 
Usually  that  upon  the  side  of  lesion  is  deeper  through  the  pa- 
tient's favoring  that  side;  bending  toward  it.     For  the  same 
reason  the  muscles  about  the  hip,  pelvis  and  lower  spine  upon 
the  opposite  side  may  be  hypertrophied. 

V.  The  spine  adjacent  to  the  pelvis  must  be  examined  for 
curvature,   swerving   to   one    side,    hypertrophy    or  tension   of 
tissues,  etc.,  secondary  to  pelvic  lesion. 

VI.  Measurements  may  be  made  from  the  mid-line  of  the 
teeth  to  the  inner  malleolus  of  each  tibia. 

TREATMENT:     Preliminary    relaxation    of    all    surrounding 
tissues  is  first  done  by  methods  already  described. 

I.  BACKWARD  LUXATIONS  and  their  combinations: 

a.  Patient  lies  upon  his  back;  the  practitioner  stands  at  the 
side  and  places  the  clenched  hand  as  a  fixed  point  beneath  the 
posterior  superior  spine  of  the  luxated  bone;  the  knee  is  flexed 
against  the  thorax  and  is  rotated  outward  strongly  enough  to 
raise  the  weight  of  the  patient  and  throw  it  upon  the  clenched 
hand.     In  this  way  the  weight  of  the  body  is  made  to  force  the 
bone  forward. 

b.  The  patient  lies  upon  his  side;  the  practitioner  stands  in 
front  of  the  pelvis,  slips  one  hand  between  the  thighs  and  grasps 
the  tuberosity  of  the  ischium,  the  other  hand  is  upon  the  pos- 
terior crest.     He  now  draws  forward  upon  the  latter  point  while 
he  pushes  backward  upon  the  tuberosity.     By  pulling  forward 
on  the  tuberosity  and  pushing  backward  on  the  crest,  the  an- 
terior displacement  of  the  bone  may  be  set. 

Commonly  one  alternately  pushes  and  pulls  to  thoroughly 
loosen  the  bone,  ending  by  the  appropriate  motion  to  set  it. 

c.  Patient  lies  upon  his  sound  side;  the  practitioner  stands 
behind  the  pelvis,  making  pressure  with  his  hand  upon  the  upper 
back  part  of  the  innominate,  while  at  the  same  time  he  draws 
the  uppermost  thigh  backward.     This  forces  the  bone  forward. 

II.  FORWARD  LUXATIONS  and  their  combinations. 

a.  The  patient  lies  on  his  side,  lesion  uppermost;  the  practi- 
tioner stands  behind  the  sacrum  and  places  his  hand  or  the  flat 


62  PRACTICE    OF    OSTEOPATHY. 

surface  of  his  knee  against  the  lower  part  of  the  sacrum,  while 
he  draws  backward  upon  the  anterior  spine  and  crest  of  the  lux- 
ated innominate. 

b.  See  "b"  above. 

III.  UPWARD  LESION. 

a.  The  patient  sits  upon  a  stool  and  an  assistant  stands 
in  front  and  fixes  the  pelvis  by  firm  pressure  downward  upon 
the  crests  of  the  ilia.     The  practitioner  stands  behind,  grasps 
the  patient's  trunk  beneath  the  axillae,  and  lifts,  turns  and  springs 
the  whole  trunk  away  from  the  side  of  lesion. 

This  same  motion  may  be  applied  to  forcing  the  body  down 
toward  the  side  of  lesion  in  downward  luxations. 

b.  For  reducing  the  upward  lesion  one  may  adopt  the  treat- 
ment described  in  chapter  VII,  A,  for  the  stretching  of  the  quad- 
ratus  lumborum  muscle. 

For  downward  luxation  see  "a"  above. 

The  SACRUM  and  COCCYX  have  already  been  discussed. 
(Chap.  I,  divs.  V,  VI,  VII;  Chap.  II  divs.  XIX,  XX)  Anterior 
or  posterior,  upward  or  downward  luxation  of  the  sacrum  may  be 
overcome  by  combinations  of  the  treatments  described  for  the 
sacrum  and  for  the  innominate. 

Spinal  treatment  must  be  given  in  conjunction  with  pelvic 
treatment  as  the  case  may  require. 

C.  GENERAL  POINTS  CONCERNING  THE  PELVIS. 

The  pudic  nerve  and  artery  may  be  located  where  they  cross 
the  spine  of  the  ischium,  and  be  reached  by  deep 'pressure.  The 
patient  lies  upon  his  side,  the  practitioner  stands  in  front  and 
bends  the  uppermost  thigh  backward  to  loosen  the  muscles 
and  tissues.  Pressure  is  made  down  upon  the  spine  at  a  point 
between  the  middle  and  lower  third  of  a  line  drawn  from  the 
posterior  superior  spine  of  the  ilium  to  the  outer  side  of  the  tuber 
ischii. 

The  gluteal  arteries  may  be  impinged  in  the  same  way  by 
deep  pressure  at  a  point  between  the  upper  and  middle  thirds 
of  a  line  drawn  from  the  posterior  superior  spine  of  the  ilium  to 
the  outer  side  of  the  great  trochanter  when  the  thigh  has  been 
rotated  forward. 


•PRACTICE    OF    OSTEOPATHY.  63 

Deep  manipulation  may  be  made  over  the  course  of  the 
iliac  blood-vessels,  beginning  at  a  point  about  two  inches  below 
the  umbilicus  and  thence  diagonally  outward  to  the  point  where 
the  femoral  vessel  leaves  the  pelvis  beneath  Poupart's  ligament. 
The  internal  iliac  artery  runs  diagonally  downward  into  the 
pelvis  from  about  the  mid-point  of  the  line  of  the  first  manipu- 
lation. 

The  spermatic  or  ovarian  vessels  may  be  manipulated  by 
deep  pressure  along  a  line  beginning  at  the  level  of  the  umbil- 
icus, one  inch  external  thereto,  and  running  down  to  enter  the 
pelvis  at  a  point  one  and  one-half  inches  internal  to  the  anterior 
superior  spine  of  the  ilium. 

In  case  of  these  vessels  one  aids  the  venous  flow  by  cen- 
tripetal progress  along  the  lines  defined.  As  an  aid  in  relieving 
or  restoring  blood-flow  in  various  pelvic  diseases  the  treatments 
are  of  value. 

The  hypogastric  plexus  is  reached  by  deep  pressure  at  a 
point  about  two  inches  below  the  umbilicus.  The  plexus  lies 
between  the  common  iliac  arteries,  just  below  the  bifurcation 
of  the  aorta. 

The  pelvic  plexuses  are  reached  a  little  lower  and  outward 
from  the  mid-line,  where  they  lie  deep  in  the  pelvis  each  side  of 
the  rectum. 

D.  OSTEOPATHIC  WORK  PER  RECTUM. 

The  index  finger  is  generally  used  in  rectal  work  as  its  use 
is  less  interfered  with  by  the  knuckles.  Proper  precautions 
for  cleanliness  and  to  guard  against  infection  must  be  employed. 
The  patient  lies  upon  the  right  side  or  stands  bent  over  a  table. 
The  examining  finger,  lubricated  with  vaseline  or  soap-suds  is 
inserted,  palm  down,  into  the  rectum.  It  notes  mal-position 
of  sacrum  or  coccyx;  weakness,  folding  or  prolapsing  of  the 
rectal  walls;  whether  the  grasp  of  the  external  sphincter  is  nor- 
mal; enlargement  of  the  prostate  gland  in  the  male;  protrusion 
of  the  cervix  or  fundus  of  the  uterus  against  the  rectum  in  the 
female;  the  presence  of  tumor  or  other  growth;  haemorrhoids, 
protruding  or  internal. 

The  prostate  gland  lies  below  the  anterior  wall  of  the  rec- 


64  PRACTICE   OF   OSTEOPATHY. 

turn  and  is  felt  in  that  position  about  one  one-half  inches  from 
the  anus.  Either  lateral  lobe,  or  the  central  lobe  may  be  enlarged. 
In  the  latter  case,  stricture  of  the  urethra  is  threatened,  as  the 
gland  surrounds  its  first  part. 

TREATMENT:  In  prolapsed  and  weakened  walls  the  finger 
should  smooth  out  the  walls  and  press  them  upward  as  far  as 
possible.  This  aids  reposition,  tones  nerves  and  blood-force, 
and  helps  to  establish  normal  tone  in  the  muscular  walls. 

A  weakened  sphincter  is  much  stimulated  by  the  simple 
insertion  of  the  finger.  It  may  be  dilated  by  introducing  two 
or  three  fingers  held  in  wedge-shape,  spreading  them  apart  upon 
withdrawal. 

For  an  enlarged  prostate  gland,  the  finger  makes  pressure 
upon  it  and  is  swept  laterally  over  it  to  aid  in  freeing  the  blood- 
flow  from  it.  Care  must  be  taken  not  to  irritate  it.  Its  surround- 
ing tissues  should  be  well  relaxed. 

In  haemorrhoids,  all  the  surrounding  tissues  are  gently 
manipulated  for  relaxation  and  to  remove  interference  with 
free  circulation,  after  which  pressure  is  made  directly  upon  the 
distended  vessels  to  empty  them  of  blood,  and  to  gently  force 
them  back  into  place  if  external.  (See  "  Haemorrhoids. ") 

Rectal  treatments  should  not  usually  be  given  oftener  than 
once  a  week  or  ten  days.  Great  care  should  always  be  exercised 
to  cause  as  little  irritation  as  may  be.  As  a  rule  these  treatments 
are  but  secondary  to  the  removal  of  pelvic  or  spinal  lesion. 

E.  OSTEOPATHIC  WORK  PER  VAGINAM. 

The  examination  is  made  with  the  index  finger  for  the 
same  reasons  as  in  the  case  of  rectal  treatment.  The  same  pre- 
cautions as  to  cleanliness,  etc.,  should  be  observed. 

As  a  rule  local  treatment  is  secondary  to  that  done  upon 
spinal  or  pelvic  lesion,  which  is  usually  the  real  cause  of  those 
conditions  which  require  local  treatment. 

It  is  proposed  here  to  review  this  subject  only  in  a  gen- 
eral way,  giving  the  main  points  in  connection  with  the  exam- 
ination and  treatment  of  this  region  as  a  part  of  the  body,  leaving 
detailed  consideration  to  the  portions  of  the  course  dealing  with 
the  specific  diseases  of  these  organs. 


PRACTICE    OF    OSTEOPATHY.  65 

I.  LOCAL  EXAMINATION:  The  patient  on  her  back  or  on 
her  side,  preferably  in  the  Sims  position.  *  In  the  latter  case 
the  practitioner  stands  behind.  The  index  finger  anointed  with 
vaseline  is  introduced,  passing  from  the  region  of  the  fourchette 
forward.  The  guiding  hand  is  placed  upon  the  abdomen  (bi- 
manual  palpation)  and  by  deep  pressure  may  aid  in  locating 
the  organ  and  in  diagnosing  its  position.  External  pressure 
over  the  region  of  the  broad  ligaments  will  sometimes  reveal 
tenderness  in  them  in  cases  of  prolapsus  uteri.  In  case  the  ten- 
derness is  unilateral  it  is  usually  in  the  ligament  suffering  from 
the  most  tension  because  of  the  organ  having  fallen  toward  the 
opposite  side. 

The  examining  finger  should  first  note  the  condition  of  the 
vaginal  walls,  which  may  be  weak  and  flabby,  or  prolapsed  and 
contorted  by  the  malposition  of  the  uterus.  The  presence  of 
enlargement  or  tumor  of  surrounding  organs  is  to  be  noticed. 
At  the  upper  extremity  of  the  vaginal  canal  is  felt  the  cervix 
protruding  into  the  canal. 

The  external  os  uteri  opens  transversely  at  the  lower  end  of 
the  cervix.  In  women  who  have  borne  children  the  external 
os  inclines  to  be  circular,  but  by  careful  examination  the  trans- 
verse axis  may  be  distinguished.  This  is  made  more  certain  by 
the  shape  of  the  cervix,  which  is  somewhat  flattened  antero- 
posteriorly.  By  these  two  points,  the  transverseness  of  the  os 
and  the  position  of  the  cervix,  the  diagnosis  of  the  position  of 
the  uterus  is  greatly  aided.  If  the  transverse  os  (or  the  longer 
transverse  diameter  of  the  cervix)  has  assumed  an  oblique  di- 
rection in  the  pelvis,  it  indicates  a  corresponding  turn  in  the 
position  of  the  organ.  This  turning  to  one  side  is  usually  com- 
bined with  the  prolapsus  or  version  of  the  organ  in  one  direction 
or  another.  , 

If  the  cervix  points  forward  and  upward,  the  fundus  has 
gone  down  and  back,  and  may  be  against  the  rectum.  In  such 
case  the  fundus  is  often  felt  through  the  posterior  vaginal  wall. 
Or  the  uterus  may  have  turned  in  falling  backward,  so  that  the 
fundus  lies  down  toward  either  sacro-iliac  region.  If  the  cervix 
points  backward  and  upward,  it  indicates  that  the  fundus  has 
descended  anteriorly  upon  the  bladder.  It  may  often  be  felt 


66  PRACTICE    OF    OSTEOPATHY. 

through  the  anterior  vaginal  wall.  There  are  all  degrees  of 
prolapsus,  and  malposition.  Some  may  be  so  slight  that  the 
cervix  and  fundus  have  deviated  but  little  from  normal  position. 
By  noting  the  direction  of  the  os,  the  direction  of  the  cervix,  and 
(if  possible)  the  position  of  the  fundus,  no  difficulty  is  usually 
experienced  in  discovering  the  form  of  malposition  from  which 
the  patient  is  suffering. 

The  different  forms  of  flexion  are  more  difficult,  but  may 
be  made  out  by  the  relative  position  of  the  cervix  and  fundus. 
For  example,  if  the  cervix  remains  near  normal  position  while 
the  fundus  is  found  backward,  retroflexion  is  diagnosed. 

In  these  cases,  retroflexion,  anteflexion,  etc.,  the  uterus  is 
bent  over  on  itself.  The  examining  finger  detects  the  bend  hi 
the  organ  by  finding  itself  in  the  space  between  fundus  and  cervix. 

Adhesions  are  noted  by  the  fixity  of  the  uterus  in  malposi- 
tion; its  resistance  to  pressure  directed  toward  its  normal  posi- 
tion, or  to  positions  assumed  by  the  patient  to  aid  in  replacing  it . 

II.  LOCAL  TREATMENT:  The  patient  may  lie  upon  the 
back,  upon  the  sid<e,  or  kneel  upon  the  table  with  the  trunk  in- 
clined forward  and  the  chest  touching  the  table. 

In  the  first  or  second  position,  the  patient  may,  while  the 
operating  finger  still  supports  the  organ,  slip  off  the  table  and 
stand  upon  the  floor,  bending  forward  to  remove  the  weight  of 
the  viscera  above,  while  the  finger  presses  the  organ  toward  its 
position.  In  any  case,  the  idea  of  the  treatment  is  to  so  manipu- 
late the  cervix,  by  pressure  or  traction,  as  to  cause  the  cervix, 
thus  the  fundus,  to  assume  its  natural  position. 

The  knee-chest  position  is  the  best  for  the  treatment  of 
such  cases.  It  allows  the  force  of  gravitation  to  act  to  draw 
the  intestines  from  the  pelvis,  which  permits  easy  reposition  of 
the  organ.  At  the  same  time  the  vagina  may  be  dilated,  and 
atmospheric  pressure  aids  materially  in  forcing  the  uterus  high 
up  to  its  position.  Moreover,  when  the  patient  has  changed  her 
position  first  onto  the  side,  then  onto  the  feet,  the  intestines  fall 
back  around  the  organ  and  help  support  it. 

The  treatment  described  in  Chap.  VIII.  div.  Ill,  may  be 
applied  to  the  external  treatment  of  pelvic  disorders. 

The  round  ligaments  of  the  uterus  may  be  located  and  may 


PRACTICE    OF    OSTEOPATHY.  67 

be  stimulated  by  pressure  upon  the  upper  margin  of  the  pub- 
ic arch,  about  a  half  an  inch  externally  from  the  symphysis. 

Inspection  of  the  female  perineum  sometimes  reveals  a 
downward  bulging  of  it  in  place  of  the  natural  slight  arch  of 
the  healthy  perineum.  Such  a  condition  indicates  prolapsus 
of  the  pelvic  viscera. 

In  child-birth,  strain  upon  the  perineum  may  be  relieved 
by  grasping  both  tubers  ischii  from  below  with  one  hand,  while 
the  other  hand  presses  the  tissues  over  the  pubic  crest  in  front 
dowrn  toward  the  perineum.  The  first  hand,  meanwhile  is  tend- 
ing to  spring  the  tuberosities  toward  each  other. 


CHAPTER  X. 
THE  LIMBS. 

I.  SHOULDER    DISLOCATIONS.     The    head    of    the    humerus 
may  be  dislocated  downward  into  the  axilla;  forward  beneath 
the  clavicle;  backward  upon  the  scapula;  or  forward  beneath 
the  coracoid  process. 

With  the  patient  sitting,  and  the  trunk  fixed  by  an  assist- 
ant, the  practitioner  stands  at  the  side,  rests  his  foot  upon  the 
stool  and  places  his  knee  in  the  patient's  axilla.  Traction  is 
now  made  directly  downward  upon  the  arm,  overcoming  the 
tension  of  the  muscles  and  drawing  the  head  back  into  the  glenoid 
fossa.  This  treatment  will  answer  for  any  of  the  dislocations. 

The  same  object  may  be  accomplished  by  placing  the  pa- 
tient upon  his  back,  while  the  practitioner  stands  at  the  side, 
places  his  stockinged  foot  in  the  axilla,  and  exerts  strong  traction 
upon  the  arm. 

II.  ELBOW   DISLOCATIONS.     The   radius   and   ulna   may  be 
both    displaced    backward,    externally    or   internally;    the    ulna 
backward;  the  radius  forward,  backward,  or  outward. 

The  patient  sits,  and  the  practitioner  stands  at  the  side 
with  his  foot  resting  upon  the  stool  and  his  knee  in  the  bend 
of  the  elbow.  The  upper  arm  is  fixed  and  traction  is  made 
strongly  upon  the  forearm.  This  will  be  sufficient  for  the  first  four 
dislocations.  When  the  radius  is  backward,  direct  pressure 


68  PRACTICE    OF   OSTEOPATHY. 

upon  it  is  sufficient  to  reduce  it.  When  the  radius  is  forward 
the  hand  is  supinated,  it  is  bent  upon  the  wrist  away  from  the 
radius,  thus  bringing  traction  upon  it,  while  pressure  is  made 
upon  the  head  of  the  bone  above.  The  outward  dislocation  of 
the  radius  is  often  accompanied  by  rupture  of  the  orbicular  liga- 
ment. It  is  reduced  by  traction  and  pressure. 

III.  WRIST  DISLOCATIONS.     The  radius  and  ulna  may  both 
be  forward,  backward,  or  outward.     Simple  traction  will  reduce 
them. 

IV.  RADIO-ULNAR    DISLOCATIONS.     The    radius    is    regard- 
ed as  the  fixed  bone,  the  ulna  being  displaced  forward  or  back- 
ward.    Direct  pressure  upon  it  will  force  it  to  its  place. 

V.  CARPO-METACARPAL   dislocations   are    more   frequent   in 
case  of  the  thumb.     Direct  pressure  will  reduce  them. 

VI.  Dislocations   of   CARPAL   bones   are   easily   reduced   by 
pressure. 

VII.  METACARPO-PHALANGEAL  dislocations  in   case   of   the 
thumb  are:  most  frequent.     For  the  backward   one,   continued 
strong  hyper-extension,    followed    by    flexion  is    used.     If  this 
treatment  does  not  succeed,  the  metacarpal  is  rotated  and  pres- 
sure is  made  upon  its  head.     In  the  forward  displacement  trac- 
tion and  pressure  are  employed,  or  strong  flexion  is  followed  by 
direct  pressure. 

In  case  of  the  fingers,  simple  traction  and  pressure  are  suf- 
ficient, as  is  also  the  case  in  PHALANGEAL  dislocations. 

These  remarks  apply  to  all  cases  of  recent  dislocation  as 
described.  It  more  often  comes  within  the  Osteopath's  province 
to  work  upon  old  dislocations,  so  frequently  given  over  as  in- 
curable. As  far  as  possible  he  applies  the  usual  motions  for  the 
reduction  of  them,  but  prepares  the  joint  for  reduction  by  ;i 
course  of  treatment  directed  to  relaxing  surrounding  muscles, 
etc. ;  to  restoration  of  free  circulation  about  the  part  and  the  up- 
building of  the  tissues.  Often  a  persistent  course  of  treatment 
restores  a  bone  to  position  when  it  had  been  given  up  as  hopeless. 
These  remarks  apply  especially  to  old  dislocations  of  the  hip- 
joint. 

GENERAL  TREATMENT  FOR  THE  UPPER  LIMB.  In  treatment 
for  various  conditions  the  arm  is  manipulated  in  special  ways. 


PRACTICE    OF   OSTEOPATHY.  69 

I.  The  shoulder- joint  may  be  sprung  to  allow  of  free  blood- 
flow  and   to   remove   tension   in   the   ligaments.     The   clenched 
hand  is  placed  in  the  axilla,  care  being  taken  not  to  press  the 
knuckles  against  the  axillary  lymphatics,  or  against  the  nerves 
and  vessels  on  the  inner  side  of  the  arm.     It  is  best  to  turn  the 
hand  sidewise.     The  patient's  arm  is  now  forced  against  his  side, 
springing  the  head  of  the  humerus  outward. 

II.  The  elbow  may  be  sprung  by  flexing  the  forearm  over 
the  hand  placed  upon  the  arm  just  above  the  bend  of  the  elbow. 
Or  the  fore-arm  may  be  flexed  to  a  right  angle,  and  the  treating 
hands  draw  it  away  from  the  lower  end  of  the  humerus.     They 
may  follow  along  down  the  fore-arm,  working  deeply  between 
radius  and  ulna  to  relax  the  interosseous  tissues. 

III.  The  branches  of  the  brachial  plexus  and  the  axillary 
artery  may  be  impinged  against  the  inner  side  of  the  humerus 
just    below    the    axilla.     Transverse    friction    reaches    all    these 
nerves  and  may  be  used  to  tone  them. 

IV.  Contracture  of  the  anterior  fibres  of  the  deltoid  muscle 
and  attendant  slight  forward  luxation  of  the  head  of  the  humerus, 
may  be  remedid  by  grasping  the  arm  just  above  the  elbow  and 
drawing  it  directly  back  and  up  to  the  level  of  the  shoulder. 
Now  the  arm  is  carried  forward  at  the  same  level,  and  the  move- 
ment is  finished  with  a  slight  upward  turn. 

V.  The  biceps  muscle  and  its  long  head  may  be  strongly 
stretched  by  drawing  the  extended  fore-arm  directly  backward 
and  upward. 

VI.  The  tendon  of  the  long  head  of  the  biceps  may  be  dis- 
placed from  its  groove,  usually  inward  causing  serious  trouble 
in  the  arm.     It  is  then  felt  upon  the  anterior  surface  of  the  hu- 
merus and  is  very  sensitive.     It  may  be  stretched  as  in  V,. after 
which  the  arm  is  flexed  and  the  tendon  is  pressed  back  into  its 
groove. 

In  such  cases  Dr.  Still  flexes  the  fore-arm  to  a  right  angle 
with  the  arm  and,  with  a  quick  motion,  swings  it  around  against 
the  front  of  the  body,  suddenly  then  raising  the  flexed  arm  out- 
ward laterally  from  the  body  up  to  a  horizontal  position.  The 
effect  of  this  motion  is  to  turn  the  groove  on  the  humerus  in  to- 
ward the  displaced  tendon,  which  lodges  against  the  caracoid 


70  -  PRACTICE    OF    OSTEOPATHY. 

process  of  the  scapula.  The  latter  thus,  so  to  speak,  is  used  to 
push  the  tendon  into  the  groove,  where  it  is  secured  by  the  sud- 
den tension  put  upon  it  by  raising  the  arm  to  the  horizontal 
position. 

GENERAL  TREATMENT  FOR  THE  LOWER  LIMB. 

I.  Strong  flexion  of  the  thigh  on  the  thorax  and  the  leg 
upon  the  thigh  stretches  the  quadriceps  extensor  muscle,  but 
particularly  the  posterior  portions  of  the  gluteal  muscles,  and 
the  gluteal  portion  of  the  sciatic  nerve.     (See  also  VI  below.) 

II.  Hyper-extension    of    the    thigh    stretches    the    anterior 
structures,    including    the   femoral   vessels   and    anterior   crural 
nerve. 

III.  Hyper-extension    of    the    foot    stretches    the    anterior 
muscles  of  the  leg.     Strong  flexion  of  the  foot  stretches  the  calf 
muscles. 

IV.  Adductor  muscles  of  the  thigh  are  stretched  by  forced 
abduction.     The   patient   lies   upon   his   back,    the   practitioner 
presses  against  one  leg  which  remains  upon  the  table,  at  the  same 
time  keeping  the  cither  leg  straight  and  abducting  it  to  the  ex- 
treme.    He  may  stand  between  the  legs.     The  same  object  is 
accomplished  by  flexion  combined  with  external  circumduction. 

V.  The  muscles  of  external  rotation  of  the  thigh  are  stretched 
by  flexion  combined  with  internal  circumduction. 

VI.  The  extensor  muscles  of  the  thigh   are   stretched  by 
raising  the  straightened  limb  to  or  beyond  right  angles  with 
the  trunk.     This  may  be  accomplished  with  the  patient  on  his 
back.     The  limb,  still  straight,  may  be  supported  at  right  angles 
while  the  foot  is  strongly  flexed  on  the  leg.     This  stretches  the 
sciatic  nerve.     This  nerve  is  also  stretched  by  motion  I.     Motion 
V  stretches  the  pyriformis,  gemelli,  and  obturator  muscles,  and 
aids  in  removing  irritation  from  the  sciatic  nerve.     All  of  the 
motions  for  stretching  this  nerve  act  partly  through  relaxation 
of  tissues  about  it. 

VII.  Pressure  at  the  midline  of  Scarpa's  triangle,  about  two 
inches  below  the  middle  of  Poupart's  ligament,   impinges  the 
femoral  vessels  and  the  anterior  crural  nerve. 

VIII.  The  popliteal  nerve  and  vessels  are  reached  at   the 


PRACTICE    OF   OSTEOPATHY.  71 

popliteal  space.  The  patient  lies  upon  his  back.  The  limb  is 
drawn  over  the  edge  of  the  table  and  the  foot  is  supported  be- 
tween the  practitioner's  knees.  Manipulation  is  now  made 
deeply  just  below  the  knee,  behind. 

IX.  Forced    flexion,    extension,    inversion   and    eversion    of 
the  foot  may  be  made  for  the  purpose  of  relaxing  all  the  liga- 
ments of  the  ankle. 

All  of  the  treatments  described  for  the  upper  and  lower 
limbs  are  given  in  a  general  way.  They  may  be  used  in  the 
treatment  of  specific  cases  in  various  ways.  One  should  not 
forget  that  they  are  used  as  aids  in  the  reduction  of  special  le- 
sions, or  as  secondary  thereto. 

X.  In  treatment  upon  the  feet  one  notes  the  two  natural 
arches,   the   transverse   and    the   longitudinal.     Springing   these 
arches  by  pressure  upon  the  arch  above  and  traction  at  the  same 
time  upon  the  ends,  aids  in  relaxing  ligaments  and  other  tissues, 
reducing    bony    luxations,    removing  pressure  from    nerves  and 
blood-vessels.     The  treatment  may  be  made  more  effective  by 
springing  the  arch  both  ways,  i.  e.,  first  applying  pressure  such 
as  to  increase  the  concavity  of  the  arch,  then  to  lessen  it. 

XI.  In  treatment  for  the  toes  the  blood-vessels,  which  lie 
upon  the  sides,  are  stretched,  and  the  tissues  about  them  re- 
laxed,   by    bending    them    laterally.     The    lateral    movements, 
combined  with  extension,  flexion,  and  traction,  free  the  joint 
and  its  nerves,  vessels  and  tissues. 

XII.  The  saphenous  opening,  an  inch  and  a  half  below  the 
inner  end  of  Poupart's  ligament,  is  often  in  an  occluded  condit- 
ion such  as  to  seriously  impede  the  flow  from  the   long  femoral 
vein.     The  muscles  and  tissues  about  it  may  be  stretched  by  ex- 
ternal rotation  of  the  flexed  knee.     Following  this  movement  by 
internal  rotation  of  the  extended  limb  relaxes  the  tissues"  still 
further  and  allows  of  direct  manipulation  upon  the  opening. 

XIII.  With  the  patient  lying  upon  the  back  one  notes  the 
angle  of  deviation  of  the  toes,  i.  e.,  the  angle  between  the  feet. 
If  one  foot  rotates  outward  too  much  or  too  little, '  it  reveals 
tenseness  or  laxness  of  the  rotators  or  ligaments  of  the  thigh,  and 
may  lead  one  to  the  discovery    of   abnormal  pelvic  or  hip  con- 
ditions. 


72  PRACTICE    OF    OSTEOPATHY. 

Concerning  DISLOCATIONS  of  the  lower  limbs,  one  must  bear 
in  mind  that  many  of  the  cases  presented  to  the  Osteopath  are. 
old  dislocations.  The  success  of  Osteopathy  in  the  reduction 
of  such  has  been  marked.  Again,  many  cases  are  met  with  in 
which  gross  dislocation  is  not  present,  but  a  slight  luxation,  or 
"slip,"  of  a  joint  has  occurred  and  has  been  overlooked  by  other 
practitioners.  The  number  of  cases  in  which  such  a  slight  dis- 
placement in  the  hip-joint  has  caused  apparent  disease  in  the 
knee,  sciatica,  lameness,  etc.,  is  remarkable.  The  fact  that 
these  things  are  commonly,  or  at  least  frequently  not  discovered 
by  others  than  Osteopaths  indicates  something  of  the  need  and 
importance  of  osteopathic  methods.  The  practitioner  must 
bear  in  mind  the  probability  of  such  occurrences,  and  must  be 
upon  his  guard  to  discover  them.  As  a  rule,  in  all  old  disloca- 
tions and  chronic  subluxations  of  this  nature,  the  really  im- 
portant osteopathic  work  is  the  preparation  of  the  parts  for  the 
restoration  of  normal  relations.  Relaxation  of  old  contractures 
in  muscles,  softening  ligaments,  development  of  atrophied  parts 
through  the  upbuilding  of  blood  and  nerve-supply  are  the  pre- 
liminary steps  taken  by  general  osteopathic  methods  already 
described.  In  case  of  such  luxations,  gross  dislocations  ex- 
cepted,  the  stand-point  of  the  Osteopath  in  diagnosis  is  a  new  one. 
This  teaching  leads  him  to  look  for  such  causes  of  disease,  which 
are  meaningless  to  other  methods  of  practice. 

I.  DISLOCATIONS  OF  THE  ANKLE:     The  displacement  may 
be  both  leg  bones  forward,  inward  or  outward.     In  either  case, 
the  patient  lies  upon  his  back,  the  knee  is  flexed,  the  leg  is  ele- 
vated to  a  right  angle  with  the  thigh  and  fixed  by  an  assistant, 
and  strong  traction  is  made  upon  the  foot.     The  muscles  draw 
the  ankle  into  place. 

II.  DISLOCATIONS  OF  THE  KNEE:     The  leg  may  be  forward, 
backward,    inward,    outward,    or   twisted.     Strong    traction   re- 
stores it  to  place. 

In  cases  of  slight  backward  luxation,  short  of  dislocation, 
a  good  method  is  to  have  the  patient  lie  on  his  back,  hang  the 
leg,  bent  at  the  knee,  over  the  edge  of  the  table,  while  the  foot 
is  supported  between  the  practitioner's  knees  and  his  hands 
work  in  the  popliteal  region.  The  hamstring  muscles  are  grasped 


PRACTICE    OF   OSTEOPATHY.  73 

by  the  two  hands  and  stretched  away  laterally  from  the  con- 
•dyles  of  the  femur,  while  the  tibia  and  fibula  are  drawn  forward. 
III.  DISLOCATIONS  OF  THE  HIP:     In  such  cases,  the  head 
of  the  bone  may  be  displaced  as  follows: 

(1)  Up  and  back  onto  the  dorsum  of  the  ilium,  shortening 
the  limb  and  turning  the  toes  inward. 

(2)  Down  and  back  onto  or  near  the  sciatic  notch,  some- 
what shortening  the  limb,  and  turning  the  toes  inward. 

(3)  Forward  and  downward  onto  or  near  the  obturator  fora- 
men (thyroid  dislocation),  in  which  the  knee  is  flexed,  the  toe 
points  to  the  ground  and  rotates  inward  and  or  outward. 

(4)  Forward  and  up  onto  the  pubic  crest.     The  toe  invari- 
ably turns  out. 

In  (2),  as  the  patient  sits  up  from  a  lying  posture,  the  limb 
shortens;  in  (3)  and  (4)  it  lengthens. 

In  the  treatment  of  such  conditions,  fresh  dislocations  are 
•set  at  once,  but  as  in  our  practice  many  old  dislocations  are  pre- 
sented, the  success  of  the  treatment  lies  largely  in  knowing  how 
to  thoroughly  prepare  parts  for  adjustment.  Much  lies  in  our 
way  of  regarding  disease,  for  even  gross  dislocations  are  often 
overlooked.  These,  and  the  many  luxations  of  lesser  degree 
found  in  osteopathic  diagnosis,  could  scarcely  be  overlooked  in 
our  method  of  minutely  scrutinizing  the  mechanical  relations  of 
all  parts  in  examination  of  a  case. 

In  (1)  the  knee  is  flexed  and  rotated  a  little  inward  to  dis- 
engage the  head  of  the  femur,  then,  while  pressure  is  made  to 
force  the  head  toward  the  acetabulum,  the  flexed  knee  is  rotated 
well  outward  and  extended.  It  is  of  great  importance  to  note 
that  during  the  outward  circumduction  and  extension  of  the  limb 
in  this  manoeuvre  the  foot  must  be  held  with  the  toes  pointing 
inward,  toward  the  body.  This  directs  the  head  of  the  femur 
toward  the  acetabulum.  This  draws  the  head  into  the  aceta- 
bulum. The  patient  is  lying  on  his  back. 

In  (2)  the  manoeuver  is  the  same,  except  that  during  out- 
ward rotation  and  extension  the  trochanter  is  grasped  and 
forced  forward  toward  the  acetabulum.  In  the  inward  rotation 
the  head  has  been  disengaged  from  the  notch. 

In  (3)   the  flexed  knee  is  rotated  far  inward,  freeing  the 


<4  PRACTICE    OF    OSTEOPATHY. 

head  from  the  obturator  foramen,  while  the  "Y"  ligament  acts 
as  a  fulcrum.  As  the  inward  rotation  is  carried  downward  to 
extension  the  head  is  forced  toward  the  cotyloid  notch. 

In  (4)  the  patient  lies  upon  his  sound  side;  the  dislocated 
thigh  is  hyper-extended  by  being  strongly  drawn  backward. 
This  stretches  all  the  muscles  about  the  head,  which,  after  slight 
flexion  of  the  thigh,  is  lifted  over  the  crest  of  the  pubes. 

In  (1)  and  (2)  the  patient  may  sit  upon  a  stool,  the  dislo- 
cated limb  is  crossed  above  the  other  knee,  the  pelvis  is  fixed 
by  an  assistant,  the  trochanter  is  pressed  by  one  hand  toward 
the  acetabulum,  while  the  other  hand  draws  the  limb  well  across 
its  fellow  and  extends  it  to  place  the  foot  on  the  floor. 

In  (1)  and  (2)  the  patient  may  stand  upon  one  foot,  sup- 
porting his  hands  upon  the  back  of  a  chair;  the  thigh  remains 
straight,  and  the  knee  is  flexed  to  a  right  angle;  the  ankle  is  sup- 
ported by  the  practitioner  who  stands  at  the  side  of  and  behind 
the  patient.  He  now  places  one  knee  upon  the  popliteal  region, 
allowing  the  weight  of  his  body  to  come  down  upon  it.  This 
forces  the  head  downward,  while  a  swing  of  the  ankle  outward 
disengages  it.  Now  a  swing  inward,  while  the  weight  is  still 
applied,  brings  the  head  into  the  acetabulum. 

These  various  motions  may  be  applied  to  subluxations  as- 
well  as  to  gross  dislocations. 


PRACTICE    OF    OSTEOPATHY.  75 


PART  II.— DISEASES. 


NOTE. — It  is  the  intention  to  deal  here  only  with  the  osteopathic  views,, 
principles,  and  methods  in  relation  to  the  various  diseases  considered.  Any 
standard  medical  text  will  supply  the  reader  with  those  facts,  theories,  etc.,. 
which  he  may  desire  to  know,  and  which  it  is  unnecessary  to  reprint  here. 


DISEASES  OF  THE  RESPIRATORY  TRACT. 

ASTHMA. 

DEFINITION:  Asthma  is  a  disease  of  the  bronchial  tubes 
characterized  by  dyspnea.  It  is  spasmodic  in  nature,  the  air 
tubes  being  narrowed  by  spasm  of  their  muscular  fibers  or  by 
swelling  of  the  mucous  membrane  from  hypermia. 

CAUSE:  This  disease  always  presents  definite  lesions,  mus- 
cular and  bony,  of  the  upper  dorsal  spine  and  of  the  thorax. 
Secondary  lesions  usually  occur  in  the  cervical  region.  The 
chief  bony  lesions  affect  the  ribs  from  the  second  to  the  sixth  on 
the  right  side.  (Dr.  A.  T.  Still.)  The  majority  of  cases  show- 
lesions  of  this  region,  but  they  may  occur  higher  up  or  lower 
down.  Lesion  is  often  found  in  the  neck.  The  sternal  ends  of 
the  ribs  and  the  costal  cartilages,  as  well  as  the  spinal  ends  of 
the  ribs  may  show  the  lesions.  Lesions  of  the  ribs  from  the  sec- 
ond to  the  seventh  on  either  side;  of  the  corresponding  dorsal 
vertebrae;  of  the  anterior  and  posterior  thoracic  muscles;  of  the 
atlas,  axis,  and  hyoid  bone,  and  of  the  cervical  muscles  are  all 
active  in  producing  the  disease.  A  case  is  reported  in  which-  the 
bony  lesion  was  in  the  lumbar  spine,  constipation  also  being  a 
feature  of  the  case.  No  treatment  was  given  above  the  lumbar 
region,  but  the  asthma  was  cured.  It  was  regarded  as  being 
reflex  from  the  lumbar  lesion.  (See  case  13). 

A  review  of  the  typical  cases,  reported  from  various  sources, 
and  in  which  cures  were  made  by  the  removal  of  the  specific 
lesion,  shows  a  definite  area  in  which  such  causes  occur. 


76  PRACTICE    OF    OSTEOPATHY. 

(1)  Luxation  of  first,  second  and  third  left  ribs. 

(2)  Fourth,   fifth  and  sixth  dorsal  vertebra  anterior:   the 
corresponding   ribs  lowered.     Two  treatments   stopped   the  at- 
tacks, and  patient  was  discharged  as  cured  after  three  weeks' 
treatment. 

(3)  Second  dorsal  vertebra  lateral. 

(4)  Fifth  right  rib  down  and  much  tenderness  of  tissues  at 
the  fifth  dorsal  vertebra. 

(5)  The  scaleni,  mastoid  and  anterior  and  posterior  thoracic 
muscles  very  tense. 

(6)  Right  fourth  and  fifth  ribs,  and  left  fifth  and  sixth  ribs 
luxated. 

(7)  The  axis  luxated  to  the  right,  cervical  muscles  contrac- 
tured,  all  the  ribs  depressed. 

(8)  The  left  fifth  and  sixth  ribs  downward. 

(9)  The  first  to  the  eighth  ribs  on  both  sides  down;  spinal 
muscles  of  the  same  region  contractured ;  luxation  of  the  atlas 
and  axis;  depression  of  the  hyoid  bone. 

(10)  The  second  dorsal  vertebra  luxated  laterally,  involv- 
ing the  corresponding  ribs;  several  ribs  down. 

(11)  All  the  upper  dorsal  vertebrae  anterior,   carrying   the 
ribs  forward:  closeness  of  the  first  rib  to  the  clavicle. 

(12)  Third,    fifth,    and    seventh    right    ribs   luxated  down- 
ward at  their  anterior  ends;  their  heads  were  also  luxated;  atlas 
and  axis  to  the  right.     The  patient  had  previously  been  a  suf- 
ferer from  bronchitis,  with  upper  dorsal  and  rib  lesions.     Ac- 
cidental slipping  of  the  third  rib  caused  asthma  at  once.     Irri- 
tation from  the  fifth  rib  always  caused  expectoration  of  quan- 
tities of  sputum,  but  if  the  third  rib  were  kept  in  place  the  asthma 
disappeared  at  once. 

(13)  Female:  age  22;  single;  book-keeper.     Lumbar  region 
much   posterior;   constipation   and   dysmenorrho?a   accompanied 
the  asthma,  which  was  of  two  years'  standing.     Xo  neck,  rib, 
or   thoracic   spinal  lesion   appeared.     The   heart    was   irregular, 
dropping  one  beat  in  four.     No  treatment  was    given  above  the 
12th  dorsal,  and  as  soon  as  the  constipation  was  cured  (3  mos.) 
the  asthma  and  dysmenorrhoea  disappeared.     The  patient  had 
not  had  a  night's  sleep  in  more  than  a  year  without  the  use  of  a 


PRACTICE    OP    OSTEOPATHY.  77 

powder  which  she  burned,  inhaling  the  fumes.  The  bony  lesion 
was  removed,  and  cure  resulted.  The  asthma  was  reflex  from 
the  lumbar  condition  and  diseases  present. 

(14)  A  fourth  rib  displaced,  causing  asthma,  accompanied 
by  bronchitis  and  pleurisy.     The  whole  spine  was  stiff.     After 
two  treatments  the  patient  was  free  from  asthma,  and  was  dis- 
charged cured  after  six  treatments. 

(15)  Asthma  and  Hay  Fever.     Male,  aged  38;  grocer.     One 
clavicle  was  depressed.     Raising  it  gave  immediate  relief.     The 
upper  spinal   muscles  were   contractured.     These  were  relaxed 
and  the  ribs,  from  the  1st  to  5th  on  the  left  side,  were  raised. 

(16)  Female,  aged  23.     A  fall  in  childhood  caused  a  lateral 
curvature  from  the  lower  dorsal  to  the  sacral  region,  the  lumbar 
reigon  being  also  anterior.     The  right  limb  was  much  smaller 
and  shorter  than  the  left;  the  ankle  stiff;  the  flesh  always  cold; 
menstrual  flow  every  two  weeks.     After  two   weeks   treatment 
the    asthma    disappeared.     Under   further    treatment    constant 
improvement  was  taking  place  in  the  general  condition. 

(17)  Male,  aged  43;  married;  overseer  of  land  and  oil  wells. 
3d,  4th,  5th,  and  6th  dorsal  vertebrae  posterior,  especially  the  3d. 
The  cervical  muscles  were  badly  contractured,  due  to  the  atlas 
being  displaced  to  the  right. 

Relief  was  given  at  once  in  treatment  by  pressing  the  dorsal 
vertebra?  forward,  throwing  the  upper  ribs  and  clavicles  for- 
ward. The  condition  was  complicated  with  hay-fever,  which 
was  also  cured. 

One  can  but  note  how  all  of  these  lesions  occur  in  those 
reigons  in  which  it  is  claimed  the  cause  of  asthma  occurs.  No 
other  school  of  practice  notices  such  causes  of  this  disease. 
Their  theories  are  various,  many  exciting  causes  are  agreed  upon, 
but  Anders  makes  the  statement  in  regard  to  the  real  and  orig- 
inal causes  that  they  are  of  an  unknown  nature. 

These  lesions  cause  abnormal  motor  effects  both  in  arousing 
spasmodic  conditions  of  the  muscles  of  the  bronchial  walls,  and 
in  the  vaso-motor  activity  that  produces  the  hyperemia  of  the 
mucous  membrane. 

There  are  good  ANATOMICAL  REASONS  why  lesions  in  these 
regions  affect  the  lungs.  The  American  Text  Book  of  Physi- 


78  PRACTICE    OF    OSTEOPATHY. 

ology  states  that  stimulation  of  the  vagus  in  the  neck  produces 
constriction  of  the  pulmonary  vessels,  while  stimulation  of  the 
sympathetics  in  the  neck  causes  dilatation  of  them.  Quain's 
anatomy  says  that  the  pneumogastrics  convey  motor  fibers  to 
the  unstriped  muscle  fibres  of  the  trachea,  bronchi,  and  their 
subdivisions  in  the  lungs.  Vaso-constrictors  for  the  lungs  ex- 
ist, in  some  animals,  in  the  second  to  the  seventh  spinal  nerves. 
(Quain.)  The  anterior  pulmonary  plexus  is  composed  of  the 
pneumogastrics  and  the  sympathetics;  the  posterior,  of  the  pneu- 
mogastrics and  branches  from  the  second,  third,  and  fourth 
thoracic  sympathetic  ganglia.  These  regions  of  the  spine,  with 
their  important  nerve  connections  with  the  lungs,  are  naturally 
investigated  by  the  Osteopath  in  relation  to  asthma.  It  is  rea- 
sonable that  obstruction  to  the  nerves  here  should  cause  the  dis- 
ease. Anders  gives  among  exciting  causes  "irritating  lesions 
of  the  medulla."  The  Osteopath  finds  in  lesions  of  atlas,  axis 
and  cervical  tissues  sufficient  cause  of  such  irritation  of  the  medul- 
la as  well  as  of  the  prieumogastric,  through  their  sympathetic 
and  spinal  nerve  connections.  In  these  ways,  lesion  to  the  cer- 
vical, dorsal  and  upper  thoracic  structures  act  as  obstructors  of 
these  nerve  mechanisms  concerned  in  asthma,  the  pneumogastric 
nerves,  pulmonary  plexuses,  sympathetic  and  vaso-motors,  and 
cause  the  disease. 

Exciting  Causes  of  the  paroxysm,  such  as  bronchitis;  the 
inhalation  of  irritants,  such  as  dust,  fog,  smoke,  chemical  vapors, 
pollen  of  plants,  odors  of  animals;  reflex  irritation  from  nose  or 
stomach;  the  results  of  other  diseases,  etc.,  would  not  act  to 
cause  asthma  did  these  anatomical  lesions  not  exist.  They  are 
the  real  cause  of  the  condition.  Existing  in  an  individual,  they 
obstruct  the  vital  forces  of  the  bronchi  and  deteriorate  the  vital- 
ity of  their  tissues,  perhaps  gradually  during  a  term  of  years, 
and  make  it  possible  for  these  various  exciting  causes  to  act. 

The  PROGNOSIS  is  good  under  osteopathic  treatment,  though 
under  medical  treatment  comparatively  few  cases  recover.  Very 
many  cases,  a  large  number  of  them  apparently  helpless,  have 
been  cured.  The  fact  that  most  of  these  cases  coming  under 
osteopathic  treatment  are  of  long  standing  and  have  usually 
tried  every  known  remedy  seems  to  make  little  difference  in 


PRACTICE   OP   OSTEOPATHY.  79 

gaining  results  upon  them.  Some  cases  the  most  severe  and 
longest  standing  yield  quickest. 

EXAMINATION  AND  TREATMENT  are  carried  out  according  to 
the  methods  described  in  Part  I,  (Chapters  I,  II,  III,  IV,  VI, 
VII.)  Any  of  the  lesions  that  may  affect  the  bony  parts  in  the 
regions  mentioned  may  produce  the  disease.  Displacements 
of  ribs,  vertebrae,  etc.,  need  not  take  place  in  a  particular  direc- 
tion. Rib  and  thoracic  vertebral  lesions  are  more  likely  to  act 
as  causes.  Lesions  in  the  neck  alone  seem  quite  unlikely  to 
cause  it.  Those  of  the  fourth  and  fifth  ribs  upon  the  right  side 
are  most  frequently  the  cause.  It  is  unnecessary  to  name. the 
various  probable  causes  of  the  anatomical  derangements  or  le- 
sions named,  as  that  subject  has  been  fully  dealt  with  elsewhere, 
as  well  as  the  theory  of  the  exact  way  in  which  such  lesions  as 
the  Osteopath  finds  act  to  cause  disease. 

TREATMENT  must  always  depend  for  its  success  upon  re- 
moving the  causative  lesion,  but  treatment  during  the  attack 
must  look  more  particularly  to  immediate  relief  of  the  patient, 
for  as  a  rule  these  lesions  can  be  removed  only  by  a  course  of 
treatments.  At  this  time  great  relief  is  given  and  the  spasm 
usually  quieted  by  thorough  relaxation  of  the  spinal  muscles 
(Chap.  II,  div.  I),  followed  by  raising  of  all  the  ribs  (Chap.  VII) 
and  clavicles  to  allow  free  thoracic  and  lung  action,  and  by  re- 
laxation of  the  muscles  and  other  soft  tissues  of  the  neck.  Loosen 
the  clothing  about  the  neck. 

The  best  time  to  treat  for  removal  of  the  lesion  is  between 
attacks,  it  being  located  and  treated,  according  to  its  kind,  by 
methods  already  described.  Attention  should  be  given  the 
sternal  ends  and  cartilages  of  the  ribs,  and  to  the  intercostal 
tissues,  as  well  as  to  the  heads  of  the  ribs  and  the  vertebrae. 
The  scapular  muscles  should  be  relaxed  (Chap.  II,  div.  XV.) 
the  clavicles  raised  (Chap.  XII);  the  tissues  of  the  neck  thor- 
oughly relaxed,  the  spinal  column  relaxed  (Chap.  II,  div.  II, 
III,  IV,  V.)  and  the  ribs  raised  at  their  angles.  If  the  patient 
finds  it  difficult  to  take  a  full  breath,  raising  or  correcting  the 
fifth  rib,  or  all  of  the  ribs,  will  sometimes  give  relief.  Pressure 
upon  the  phrenic  nerve  aids  the  work  by  relaxing  the  diaphragm, 
which  is  sometimes  elevated  (Chap.  Ill,  div.  VIII.) 


80  PRACTICE    OF    OSTEOPATHY. 

Treatment  once  a  week  or  ten  days  is  often  enough  in  most 
cases.  Frequent  treatment  may  undo  the  results  accomplished 
and  keep  up  constant  irritation.  Many  severe  cases  have  been 
cured  by  a  few  treatments  at  long  intervals  or  by  a  single  treat- 
ment. 

Under  this  course  of  treatment  the  patient  usually  feels 
relief  at  once.  As  a  rule  the  spasms  and  the  various  attend- 
ant symptoms  terminate  abruptly. 

CARE  OF  PATIENT  should  include  the  wearing  of  loose  clothing, 
living  out  of  doors  in  pure  air  if  possible,  or  in  large,  well  ven- 
tilated rooms.  The  diet  should  be  light  and  easily  digested  to 
avoid  danger  of  stomach  reflexes,  and  the  patient  should  avoid 
dust  and  other  exciting  causes. 

BRONCHITIS. 

Bronchitis  is  an  acute  or  chronic  inflammation  of  the  mucous 
membrane  of  the  large  and  .middle  sized  air  tubes.  It  is  attended 
by  increased  secretions  and  cough,  and  is  caused  by  a  vaso-motor 
disturbance  of  the  vessels  of  those  membranes,  due  to  specific 
lesions  in  the  upper,  spinal,  anterior  and  posterior  thoracic,  and 
cervical,  regions.  These  lesions  may  be  bony  displacements,  ' 
muscular  contractures,  ligamentous  derangement,  etc. 

CAUSE:  These  specific  lesions  cause  the  condition  by  ob- 
structing peripheral  nerves  or  centers  connecting  with  the  vaso- 
motor  innervation  of  the  bronchi.  They  usually  occur  high  up 
in  the  thorax,  and  in  the  neck,  in  close  relation  to  the  vaso-motor 
areas  for  the  bronchi. 

LESIONS  found  causing  bronchitis  are  typified  by  the  fol- 
lowing cases:  (1)  Luxation  of  atlas  and  axis,  depression  of 
hyoid  bone,  lowering  of  upper  eight  ribs,  congestion  of  spinal 
muscles.  (2)  Third  cervical  vertebra  anterior,  muscular  tension 
from  the  second  to  the  sixth  dorsal  vertebra,  second  left  rib  much 
depressed.  (3)  Fourth  dorsal  vertebra  lateral.  (4)  Luxation 
of  clavicle  and  first  rib  anteriorly.  (5)  Anterior  and  posterior 
intercostal  spaces  as  low  as  the  fourth  or  fifth  either  changed  by 
misplacement  of  rib,  or  the  seat  of  irritation  to  the  intercostal 
structures  by  contracture.  (6)  Lesion  to  the  vagus  nerve  by 
cervical  luxation  and  contracture,  also  luxation  of  the  four  upper 


PRACTICE   OF    OSTEOPATHY.  81 

dorsal  vertebrae.  (7)  Luxation  of  the  first,  second  and  third 
ribs.  (8)  Displacement  of  the  anterior  ends  of  the  first,  second 
arid  third  ribs,  and  derangement  of  these  cartilages.  (9)  Bi- 
lateral contracture  of  the  cervical  and  spinal  muscles  as  low  as  the 
sixth  dorsal.  (10)  Second  to  fourth  dorsal  vertebrae  lateral. 

(11)  Luxation  between  manubrium  and  gladiolus  of  the  sternum. 

(12)  A  case  accompanied  by  torticollis  and  a  weak  heart  in  a 
female,    age   24,    teacher   by   occupation.     Upper  four   cervical 
vertebrae  to  the  right  and  ankylosed ;  a  lateral  swerve  of  the  spine 
from  the  4th  to  9th  dorsal. 

The  ANATOMICAL  RELATIONS  between  these  lesions  and  the 
seat  of  the  disease  are  clear.  While  generally  located  higher 
than  in  the  case  of  asthma,  they  still  fall  within  the  vaso-motor 
area  to  the  lungs.  As  to  lesion  of  atlas,'  axis,  and  other  cervi- 
cal tissues,  in  relation  to  the  vagus  and  cervical  sympathetics, 
as  well  as  of  the  upper  dorsal  vertebras,  ribs,  and  muscles  to  the 
vaso-motor  innervation  of  the  bronchi,  the  same  remarks  apply 
as  in  case  of  asthma,  q.  v.  Noting  from  the  above  lesions  that 
they,  being  higher,  are  more  concentrated  upon  the  vaso-motor 
centers  of  the  bronchi  (2nd,  3rd,  4th  dorsal),  may  explain  in  part 
the  reason  for  a  more  intense  vaso-motor  effect,  necessary  to  pro- 
duce the  inflammation  of  the  membranes.  Luxations  of  the 
clavicle  and  first  rib  anteriorly  are  anatomically  related  to  the 
disease  as  causing  contracture  of  the  anterior  deep  cervical  tissues, 
thus  obstructing  both  phrenic  and  pneumogastric  nerves,  con- 
cerned in  innervation  of  the  lungs,  retarding  the  circulation  of 
the  cervical  vessels,  and  collaterally  obstructing  circulation  in 
ihe  lungs.  The  general  dilatation  of  the  air  tubes,  often  seen  in 
chronic  cases,  is  likely  caused  by  those  lesions  especially  affecting 
the  vagus,  which  innervates  the  involuntary  muscles  regulating 
the  calibre  of  the  bronchi.  Lessened  action  of  the  nerve  allows 
a  dilatation  of  the  tubes  through  loss  of  those  muscle  fibers.  The 
same  explanation  probably  accounts  for  local  thinning  and  di- 
latation of  the  walls  of  the  tubes. 

Osier's  statement  that  the  cause  of  the  disease  is  probably 
microbic  is  a  confession  that  the  real  cause  is  not  known.  We 
hold  the  true  cause  to  be  anatomical  lesions  as  described.  The 
fact  that  the  disease  is  bften  the  sequel  of  catching  cold  is  sug- 


82  PRACTICE    OF    OSTEOPATHY. 

gestive  from  an  osteopathic  point  of  view.  The  contraction  of 
muscles  and  tissues  from  exposure  may  be  sufficient  lesion,  or 
may  produce  actual  bony  luxations  by  drawing  parts  out  of 
place.  The  further  fact  that  the  subjects  of  spinal  curvature 
are  prone  to  the  disease  is  a  confirmation  of  the  osteopathic  idea 
of  making  bony  lesions  the  cause.  Also,  it  is  significant  to  note 
that  the  obese  are  particularly  subject  to  bronchitis  because  the 
weight  of  the  flesh  aggregated  about  the  chest  walls  acts  as  a 
mechanical  impediment  to  free  rib-action — free  breathing,  thus 
favoring  sluggish  circulation  and  weak  tissues  which  are  prone  to 
congestions  and  inflammations. 

The  PROGNOSIS  is  good  for  both  acute  and  chronic  cases. 
Many  of  the  latter  are  cured  in  a  comparatively  short  time, 
varying  usually  from  one  month  or  less  to  three  months.  In 
the  former  the  first  treatment  gives  great  relief,  and,  if  the  case 
is  seen  early  enough,  may  abort  the  attack.  A  few  treatments 
usually  start  the  patient  well  on  the  way  to  recovery,  and  as  a 
rule  he  is  well  in  about  half  of  the  time  these  cases  usually  run, 
which  is  stated  to  be  two  or  two  and  a  half  weeks. 

In  the  TREATMENT  of  the  case  the  specific  lesions  should 
be  at  once  sought  and  treated.  Often  relief  can  be  given  only 
in  this  way.  A  thorough  treatment  should  be  given  the  spine, 
thorax  and  neck  to  relax  all  contracted  tissues.  Easing  of  the 
tension  in  this  way  gives  great  relief,  as  the  constriction  of  the 
chest  and  neck  causes  much  of  the  discomfort  from  which  the 
patient  suffers.  This  is  aided  by  raising  all  the  ribs.  Treatment 
of  the  neck  corrects  the  action  of  the  vagus  and  aids  in  dispelling 
the  inflammation  by  its  participation  in  the  vaso-motor  control. 
In  the  same  way  relaxation  of  all  the  tissues  of  the  dorsal  region 
about  the  second,  third,  and  fourth  vertebrae  particularly,  also 
correction  of  these  vertebrae  themselves,  tends  to  the  same  end. 
The  clavicle  should  be  raised  and  the  first  rib  lowered  to  free  irrita- 
tion to  the  phrenic,  vagus,  and  cervical  vessels.  Thorough  treat- 
ment of  the  spine  from  the  second  to  the  seventh  dorsal  vertebra 
(vaso-motor  area)  aids  in  equalizing  bronchial  circulation,  the 
work  on  the  left  side  as  low  as  the  sixth  aiding  this  result  by 
strengthening  the  pulse  beat.  This  initial  portion  of  the  treat- 
ment should  be  brisk  and  energetic  enough  to  arouse  good  re- 


PRACTICE    OF   OSTEOPATHY.  83 

action.  It  relieves  the  patient  at  once  of  the  constriction,  languor, 
and  aching  pain  in  the  back.  It  frees  the  lungs  and  starts  per- 
spiration. 

The  patient  should  be  laid  on  his  back  and  the  upper  an- 
terior ribs,  cartilages  and  intercostal  structures  be  thoroughly 
treated.  Strong  manipulation  of  the  tissues  upon  the  anterior 
chest  and  along  the  sternum  reddens  them  and  acts  as  a  mus- 
tard plaster  would.  These  treatments,  together  with  treat- 
ment directly  along  the  trachea  in  the  neck  will  relieve  the  cough. 
The  pain  along  the  sternum  is  relieved  by  raising  the  ribs  and  by 
the  above  treatments  along  the  anterior  chest.  The  fever  is 
taken  down  by  the  equalization  of  circulation  wrought  by  the 
general  treatment,  and  by  pressure  in  the  superior  cervical  re- 
gion, affecting  the  superior  cervical  ganglion  via  the  upper  cervical 
nerves.  The  blood-flow  may  be  diverted  from  the  bronchi  to 
the  abdomen  by  a  slow,  deep,  inhibitive  treatment  over  it,  in- 
cluding pressure  over  the  solar  and  hypogastric  plexuses.  By 
the  process  of  raising  the  ribs  and  treating  the  spine,  the  en- 
gorged azygos  major  vein  is  emptied.  The  restoration  of  free 
thoracic  play  by  these  treatments  is  an  important  consideration 
in  the  equalizing  of  the  circulation  throughout  the  lungs. 

A  hot  mustard  plaster  over  the  anterior  chest,  or  a  hot  full 
bath,  are  efficient  aids. 

An  acute  case  should  be  treated  daily  at  least  once,  and 
oftener  in  case  of  need.  One  thorough  general  treatment  daily 
may  be  sufficient  of  the  kind,  some  additional  special  treatment 
being  given  for  cough  or  fever  at  other  times.  In  chronic  cases 
the  treatment  should  be  given  two  or  three  times  a  week.  In 
case  of  local  or  general  dilatation  of  the  bronchi,  and  in  the  thin- 
ning of  the  walls,  close  attention  to  the  vagus  nerve  should  be 
given  for  reasons  already  explained. 

Good  care  should  be  taken  of  the  patient,  particularly  as 
to  guarding  against  exposure,  which  may  lead  to  complications. 
Treatment  should  be  given  bowels  and  kidneys  to  keep  them 
active.     The  obese  should  be  taught  the  habit  of  deep  respiration 
as  should  all  persons  subject  to  attacks  of  the  disease.     This 
measure,  together  with  the  daily  cold  sponge  or  shower  bath,  is 
a  great  aid  in  overcoming  the  chronic  tendency. 


84  PRACTICE    OF   OSTEOPATHY. 

BRONCHIECTASIS  is  successfully  treated.  The  condition 
frequently  comes  under  treatment  as  a  complication  in  chronic 
bronchitis,  asthma,  etc.,  being  benefited  or  perhaps  practically 
cured  along  with  the  primary  condition.  As  this  condition  is  gen- 
erally a  result  of  chronic  bronchial  catarrh,  and  is  frequently 
associated  with  emphysema,  chronic  bronchitis,  and  asthma, 
the  lesions  found  causing  it  are  similar  to  those  found  in  these 
diseases.  One  would  expect  such  lesions  as  have  been  pointed 
out  as  the  cause  of  vaso-motor  derangement  in  the  bronchi, 
leading  to  the  chronic,  catarrhal  condition  which  so  often  causes 
it.  These  lesions  occur  mostly  in  the  upper  dorsal  region,  be- 
tween the  2d  and  7th.  One  notes  that  in  bronchitis  the  dilata- 
tion of  the  air-tubes  is  probably  due  to  lesion  to  the  vagus  nerve, 
whose  fibers  innervate  the  muscles  controlling  the  calibre  of  the 
tubes.  Hence  cervical  lesion  to  the  vagus  might  be  the  cause 
of  the  disease.  The  lesion  may  be  entirely  those  of  the  primary 
condition,  followed  by  bronchiectasis,  as  in  cases  in  which  the 
tumors,  aneurysms,  enlarged  glands,  cicatricial  contractions  in 
interstitial  pneumonia,  etc.,  cause  mechanical  obstruction  of  the 
bronchi  and  lead  to  their  dilatation. 

The  TREATMENT  of  this  condition  would  give  much  relief, 
but  it  is  questionable  whether  the  majority  of  cases  could  be 
cured  entirely.  They  are  frequently  much  helped  by  the  treat- 
ment of  a  case  of  asthma,  chronic  bronchitis,  etc.  Some  cases 
have  been  cured. 

The  removal  of  a  foreign  body  or  other  obstructing  cause 
as  pointed  out  above;  the  removal  of  lesion  from  blood  and 
nerve-supply  of  the  bronchi:  thorough  stimulation  of  the  vagi 
to  give  renewed  tone  to  the  muscles  in  the  bronchial  walls  and 
to  aid  their  contraction;  treatment  of  the  bronchial  vaso-motor 
center  (2nd  to  7th  dorsal)  to  aid  in  strengthening  the  bronchial 
walls  and  in  overcoming  the  chronic  catarrhal  condition  of  their 
lining  membranes,  are  all  necessary.  In  this  way  the  case  could 
be  much  improved.  The  purulent  and  fetid  expectorations 
would  be  remedied  as  the  renewed  blood-flow  began  to  restore  the 
secretions  to  their  normal  quality.  To  some  extent  the  structural 
changes  in  the  bronchi  could  be  repaired  and  their  further  pro- 
gress prevented. 


PRACTICE    OF    OSTEOPATHY.  85 

i 

HAY-FEVER. 

DEFINITION:  Hay-fever,  or  Autumnal  Catarrh,  is  a  dis- 
ease of  the  upper  respiratory  tract,  styled  by  some  writers  a 
form  of  asthma.  It  is  caused  by  specific  lesions  in  the  upper 
dorsal,  thoracic  and  (especially)  cervical  regions,  which  deteriorate 
the  vitality  of  the  membranes  of  this  tract  and  lay  them  liable  to 
the  effect  of  certain  irritants,  such  as  the  pollen  of  various  plants, 
leading  to  an  inflammatory  or  catarrhal  condition. 

LESIONS:  The  anatomical  causes  for  this  condition  are, 
from  the  osteopathic  point  of  view,  held  to  be  derangements, 
in  the  regions  mentioned,  of  bones  or  other  tissues,  which  act 
as  lesions  upon  the  motor,  vaso-motor  and  sensory  innervation, 
also  upoji  the  blood-vessels  of  the  upper  respiratory  tract. 

CASES:  (1)  In  one  case,  complicated  with  asthma  and 
bronchitis,  the  scaleni,  stern o-mastoid,  and  anterior  and  pos- 
terior thoracic  muscles  were  contractured.  (2)  In  another, 
lesions  were  found  affecting  the  inferior  cervical  and  upper  thoracic 
regions. 

In  other  cases  lesions  were  found  as  follows:  (3)  Right 
fifth  rib;  (4)  contracture  of  the  muscles  from  the  1st  to  10th 
dorsal  vertebra,  with  ribs  in  this  region  drawn  down;  (5)  sec- 
ond cervical  vertebra  to  the  right  and  posterior ;  (6)  second  cervi- 
cal vertebra  right,  cervical  muscles  contractured,  upper  three 
or  four  dorsal  vertebrae  to  the  right.  (7)  See  "Asthma,"  case 
15;  (8)  see  "Asthma,"  case  17.  In  addition  to  these,  lesions  of 
the  atlas,  of  the  phrenic  nerve,  of  the  clavicles  and  upper  three 
ribs  (especially  the  first)  and  of  the  dorsal  vertebrae  as  far  as  the 
fifth  are  all  found. 

The  fact  that  this  disease  is  often  found  complicated  with 
asthma  and  bronchitis  is  readily  explained  by  noting  that  lesions 
for  all  of  these  conditions  occur  at  the  same  area  of  the  spine. 
In  all,  as  well,  vaso-motor  lesion  seems  a  more  potent  cause  than 
motor  lesion.  In  the  case  of  hay-fever,  as  with  the  other  two, 
upper  cervical  lesion  is  less  important  than  lower  cervical  lesion. 
The  latter  kind,  with  those  affecting  the  first  few  dorsal  verte- 
brae, the  clavicle  and  the  first  and  second  ribs,  are  always  ex- 
pected in  case  of  hay-fever.  Purely  muscular  lesions  are.  rela- 


86  PRACTICE    OF    OSTEOPATHY. 

lively  less  important  than  other  kinds  as  they  are  more  likely 
to  be  secondary  lesions. 

The  ANATOMICAL  RELATION  of  lesion  to  disease  in  this  case 
seems  clear.  The  lesions  mentioned  affect  the  vagus,  cervical 
sympathetic,  and  vaso-motor  nerves  as  already  explained.  They 
also  affect  the  fifth  cranial  nerve  through  the  cervical  sympathetic, 
including  the  superior  cervical  ganglion.  This  is  the  nerve  which 
causes  the  swollen  and  painful  face,  the  running  eyes  and  nose, 
and  the  sneezing,  all  of  which  are  so  noticeable  in  hay-fever. 

The  fifth  nerve  and  the  vagus  are  intimately  related  in 
function,  both  of  the  respiratory  and  of  the  digestive  tract, 
and  are  closely  connected  by  the  floor  of  the  fourth  ventricle, 
the  superior  ganglia,  and  the  cervical  sympathetic.  Lesions  to 
the  vagus  in  the  region  of  the  clavicle  and  first  rib,  and  to  the 
sympathetic  in  the  cervical  region  and  in  the  upper  thoracic 
region  of  the  spine,  may  affect  one  or  both  of  these  nerves.  Ac- 
cording to  Ho  well's  American  Text  Book  of  Physiology,  vaso- 
dilator fibers  for  the  face  and  mouth  leave  the  cord  at  the  2d  to 
5th  dorsal,  pass  up  the  cervical  sympathetic  to  the  superior  cer- 
vical ganglion,  thence  to  the  Gasserian  ganglion  of  the  fifth  and 
to  the  regions  mentioned.  Thus  a  low  lesion,  affecting  nerves 
which  ascend  to  supply  these  parts,  may  be  sufficient  cause  of 
hay-fever.  At  the  same  time  the  close  association  of  this  disease 
with  asthma  is  shown,  since  the  vaso-motors  to  the  lungs  occupy 
this  same  region  of  the  upper  thoracic  spine. 

"Modern  Medicine"  describes  Hay-Fever  as  "A  vasomotor 
paralysis." 

While  the  common  form  of  irritant  producing  the  attack 
is  supposed  to  be  dust  or  pollen  in  the  atmosphere,  the  fact  that 
emotional  excitement,  a  deflected  nasal  septum,  the  presence 
of  a  nasal  polypus,  hypertrophied  mucous  membranes,  etc., 
may  produce  attacks,  shows  that  there  are  other  causes,  some  of 
them  mechanical,  accounting  for  an  irritable  nasal  mucous  mem- 
brane or  acting  as  an  irritant  upon  it.  It  is  reasonable  for  an 
Osteopath  to  maintain  that  lesions  act  as  obstructions  to  natural 
nerve  and  blood-supply  to  these  membranes,  weaken  them  and 
lay  them  liable  to  the  action  of  various  irritants,  thus  being  the 
real  cause  of  the  disease.  Immunity  from  attack  in  certain  cli- 


PRACTICE    OF   OSTEOPATHY.  87 

mates  or  altitudes  is  but  alleviation,  or  possibly  cure,  by  allowing 
Nature  a  chance.  The  patient  has  gone  away  from  the  special 
irritant  which  produces  the  attack  in  him.  The  real  causes  of 
the  disease  still  exist,  and  it  generally  returns  upon  his  again  ex- 
posing himself  to  the  same  irritant.  Although  a  patient  is  more 
liable  to  attacks  in  rural  districts,  more  city  people  contract  the 
disease,  showing  that  a  locality  in  which  much  pollen  occurs  has 
nothing  to  do,  per  se,  with  the  matter.  Osier  says  that  McKenzie 
induced  attacks  by  offering  the  patient  an  artificial  rose  to  smell. 
Osier  states  that  three  elements  are  necessary  to  the  production 
of  the  disease;  "a  nervous  constitution,  an  irritable  nasal  muscosa, 
and  the  stimulus."  Yet  nervous  people,  with  colds  or  catarrhal 
inflammation  of  the  nasal  membranes,  may  be  with  impunity 
in  districts  filled  with  the  common  irritants  which  excite  attacks 
in  hay -fever  subjects.  Evidently  some  further  etiological  fac- 
tor is  necessary,  and  is  found  in  the  specific  anatomical  abnormality 
pointed  out  by  the  Osteopath,  the  removal  of  which  has,  in  great 
numbers  of  cases,  cured  the  disease.  The  most  severe  cases 
yield  quickly,  often,  upon  the  removal  of  the  specific  lesion. 
The  length  of  standing  of  the  case  seems  to  have  but  little  rela- 
tion to  the  length  of  the  time  necessary  to  cure.  A  case  of  fourteen 
years'  standing  was  cured  in  three  weeks;  one  of  twenty-four 
years,  in  three  months;  one  of  five  years,  in  one  and  one-half 
months.  This  rehearsal  might  detail  great  numbers  of  cases,  but 
the  few  mentioned  illustrate  the  whole  matter.  In  view  of  these 
facts  it  seems  incontrovertible  that  the  specific  lesions  found  by 
the  Osteopath,  and  held  by  him  to  be  the  cause  of  disease,  are 
the  actual  causes  of  this  disease. 

The  PROGNOSIS,  under  osteopathic  treatment,  is  good.  Many 
of  the  cases  are  cured.  The  most  severe  and  oldest  cases  may  be 
safely  encouraged  to  take  the  treatment.  Of  medical  prognosis 
in  hay-fever,  Anders  says  that  permanent  cure  is  a  rare  event. 

THE  EXAMINATION  AND  TREATMENT.  The  removal  of  le- 
sion is  the  first  consideration.  It  may,  occuring  in  the  region 
described,  be  any  one  of  the  mal-adjustments  of  tissue  considered 
in  the  general  chapters  relative  to  the  examination  and  treat- 
ment of  the  parts.  An  immediate  effort  should  be  made  for  its 
removal.  In  addition  special  treatment  is  given  to  alleviate  the 


88  PRACTICE    OF    OSTEOPATHY. 

condition.  All  the  upper  spinal,  thoracic  and  neck  muscles,  and 
deep  tissues  should  be  thoroughly  relaxed  for  freedom  of  circula- 
tion and  to  release  tension  upon  nerves.  The  ribs  and  clavicles, 
apart  from  correction  of  displacement,  should-  be  raised.  At- 
tention should  be  given  to  releasing  and  toning  the  vagus  nerve, 
and  the  vaso-motor  nerves  from  the  2nd  to  the  8th  dorsal.  For 
lachrymation,  itching  of  the  eyes,  swelling  and  pain  in  the  face, 
and  rhinorrhoea,  special  treatment  should  be  given  the  fifth  nerve. 
This  may  be  aided  by  deep  manipulation  and  pressure  in  the  sub- 
occipital  fossa?  for  the  superior  cervical  ganglion,  but  is  done  es- 
pecially by  relaxation  and  quiet,  deep,  inhibitive  treatment  to 
the  facial  branches  of  the  fifth  nerve  (Chap.  V.  B.)  Treatment 
is  given  along  the  sides  of  the  nose  (Chap.  V.)  to  free  its  blood 
vessels,  nerves,  and  to  reduce  the  swelling  and  irritation  in  the 
mucous  membranes.  Strong  pressure  is  made  with  the  palm 
upon  the  forehead  (Chap.  V.  B.  II)  to  open  the  nostrils.  Cer- 
vical treatment,  inhibition  at  the  superior  cervical  region,  and 
opening  the  mouth  against  resistance  (II,  Chap.  IV),  all  relieve 
the  congested  circulation  about  the  head  and  face,  and  give  much 
relief.  Momentary  pressure  upon  both  external  jugular  veins 
causes  the  blood  in  them  to  set  back  and  dilate  the  veins  back  to 
the  capillaries,  after  which,  being  dilated,  they  carry  off  more 
blood,  relieving  the  congestion. 

For  the  sneezing  one  may  make  inhibition  of  the  phrenic 
nerve  (Chap.  Ill,  VIII),  may  press  upon  the  palatine  branches 
of  the  fifth  nerve  where  they  run  over  the  hard  palate,  or  may 
grasp  the  head  as  in  Chap.  V,  div.  IX,  4,  and  raise  it  from  the 
spine.  The  latter  is  a  particularly  good  treatment. 

Treatment  is  ordinarily  given  three  times  per  week.  The 
patient  should  be  kept  from  exposure  to  the  particular  irritant 
that  excites  his  attacks. 

PNEUMONIA. 

DEFINITION:  Lobar  Pneumonia,  or  Lung  Fever,  is  an  acute 
inflammation  of  the  parenchyma  of  the  lungs  caused  by  specific 
lesions,  bony,  muscular,  or  ligamentous,  in  the  upper  spinal, 
thoracic,  and  cervical  regions.  In  other  forms  of  pneumonia  the 
same  lesions  are  found.  Lobular  or  Catarrhal  Pneumonia  is  an 


THE  PRACTICE   OF  OSTEOPATHY.  89 

inflammation  of  the  capillary  air  tubes,  which  extends  also  to 
the  lung  tissue  proper.  Chronic  Interstitial  Pneumonia  is  charac- 
terized by  increase  of  the  interstitial  connective  tissues. 

CASES:  (1)  In  this  case,  acute  lobar  pneumonia,  lesion 
existed  at  the  2nd  to  5th  dorsal  vertebrae;  the  intercostal,  cer- 
vical, and  spinal  muscles  were  contractured. 

(2)  Marked  contracture  of  the  spinal  muscles  about  the  lung 
center  (2nd  to  7th  dorsal). 

(3)  Acute  lobar  pneumonia  in  a  woman,  aged  38.  Temper- 
ature, 102  5-10;  pulse,  100;  respiration,  38.     Cervical  and  dorsal 
spinal  muscles,  as  well  as  the  intercostals,  were  rigid;  vertebral 
lesion  from  the  2nd  to  5th  dorsal  inclusive.     The  crisis  was  reached 
upon  the  second  day  of  treatment,  after  which  time  no  serious 
symptoms  existed.     On  the  fifth  day  temperature,  pulse,  and 
respiration  were  found  normal  and  so  remained. 

(4)  A  case  in  which  the  temperature  was  found  at   105. 
The  cough  could  be  well  relieved  each  time  by  steady  pressure 
at  the  2nd,  3rd  and  4th  dorsal;  the  pain  in  the  side  was  relieved 
by  raising  the  ribs  and  pressing  on  the  left  side  from  the  6th  to 
8th  ribs.     The  crisis  was  reached  in  seven  days  and  the  patient 
was  out  upon  the  12th  day. 

CAUSES:  Anatomical  lesion  in  the  form  of  displaced  bony 
parts,  ligaments,  etc.,  and  of  contractured  or  tensed  muscles 
and  other  soft  tissues  are  found  affecting  the  spine  as  low  as  the 
eighth  or  ninth  dorsal;  the  ribs  in  the  corresponding  region,  but 
more  generally  the  1st,  2nd  and  3rd,  4th  and  5th;  the  intercostal 
tissues,  including  nerves  and  vessels;  the  cervical  vertebrae  and 
tissues;  the  clavicle  and  first  rib.  More  specifically,  lesions  have 
been  found  affecting  the  2nd  to  5th  dorsal  vertebrae;  contracture 
of  intercostal,  cervical  and  spinal  muscles;  thoracic  muscles; 
4th  and  5th  ribs;  8th  and  9th  ribs;  the  vaso-motor  area,  the  2nd 
to  7th  dorsal;  neck  lesions  to  the  vagi;  to  the  recurrent  laryngeal 
nerves  at  the  1st  and  2nd  ribs. 

Dr.  Still  says  that  in  pneumonia  the  ribs  below  the  4th  are 
twisted  and  the  lower  ribs  are  down.  He  lays  some  stress  in 
these  cases  upon  sacral  lesion,  acting  by  effect  through  the  sympa- 
thetic system  to  constrict  the  blood-vessels  of  the  superficial 
fascia,  and  to  thus  throw  congestion  onto  the  lungs. 


90  PRACTICE    OF    OSTEOPATHY. 

The  ANATOMICAL  RELATIONS  of  such  lesions  to  the  lungs 
have  been  explained.  It  is  to  be  noted  that  the  neck  lesions  as- 
sume greater  importance  in  these  cases  than  in  asthma  or  bron- 
chitis, though  there  is  considerable  concentration  of  lesion  about 
the  portion  of  the  spine  in  which  is  located  the  most  important 
vaso-motor  area  for  the  lungs,  the  region  as  low  as  the  fourth 
dorsal.  In  regard  to  neck  lesion,  important  consideration  are 
pointed  out  by  McConnell  in  regard  to  the  vagi  and  the  recurrent 
laryngeal  nerves.  Such  obstructions  to  the  vagi,  which  are  motor 
nerves  to  the  lung,  cause  loss  of  motor  power  in  them  and  favor 
the  stasis  and  engorgement  present.  Obstruction  to  the  recur- 
rent laryngeal  nerves  by  luxations  of  the  1st  and  2nd  rib,  or  by 
engorgement  of  aorta  or  sub-clavian  artery  where  they  are  in 
relation  to  them,  causes  catarrhal  inflammation  of  the  air  tubes. 
Lesions  of  the  8th  and  9th  ribs,  affecting  fibres  to  the  lower  lobes 
of  the  lungs,  are  more  usual  in  cases  in  which  the  disease  occurs 
in  the  lower  lung. 

The  fact  that  more  men  than  women  are  attacked  by  the 
disease;  that  a  debilitated  system  is  more  susceptible;  that  ex- 
posure, winter  season,  and  trauma  are  exciting  causes,  favors 
the  theory  that  such  anatomical  lesions  cause  the  disease,  for  the 
reason  that  t  such  conditions  are  fruitful  sources  of  mechanical 
lesions.  The  result  may  be  caused  directly  by  them,  or  they 
may  make  the  anatomical  weak  points  that  lead  to  deterioration 
of  the  lung  tissues  and  lay  them  liable  to  invasion.  The  specific 
microbes  found  in  such  cases  could  not  live  and  grow  in  tissues 
whose  vitality  had  not  been  weakened  by  such  causes.  It  is 
of  interest,  in  this  connection,  to  note  the  remark  of  Strumpell ; 
that  the  diplococcus  pneumonise  exists  in  the  mouths  of  healthy 
persons. 

If  the  case  be  seen  before  it  has  passed  the  stage  of  en- 
gorgement, the  fever  may  be  gotten  under  control  at  once,  and 
a  few  treatments  may  abort  the  disease. 

This  is  the  experience  of  our  practitioners,  although  Osier 
says  that  the  disease  can  neither  be  aborted  nor  cut  short 
by  any  means  (medical)  at  command.  The  means  at  the  Osteo- 
path's command  to  control  vaso-motor  action  are  sufficient  to 
relieve  the  engorgement.  In  the  stages  of  red  and  gray  hepatiza- 


PRACTICE    OF    OSTEOPATHY.  91 

tion  it  is  natural  that  slower  results  must  be  expected,  as  the 
treatment  has  more  work  to  accomplish.  Yet  vaso-motor  cor- 
rection must  lessen  the  inflammatory  process,  allow  of  less  solidi- 
fication, and  hasten  the  process  of  resolution. 

In  the  first  stage  there  is  better  opportunity  to  correct  the 
specific  lesion,  as  the  patient's  strength  will  allow  of  such  treat- 
ment. The  work  is  also  aided  by  the  fact  that  the  alveoli  are 
still  open,  and  lung  action,  stimulated  by  treatment,  may  become 
a  valuable  aid  in  dispelling  the  engorgement.  In  view  of  these 
facts,  and  as  experience  shows,  every  symptom  of  the  case  can 
be  lessened  because  the  pathological  processes  are  modified. 
Less  poison  is  generated  and  the  patient's  general  condition  re- 
mains better.  In  one  case  the  treatment  was  applied  in  the  first 
stage ;  the  fever  was  under  control  from  the  first,  and  the  temper- 
ature became  normal  in  three  days.  In  another  it  disappeared 
in  four  days;  in  another  in  five  days.  A  case  in  which  the  tem- 
perature was  104V2  degrees  when  first  seen  showed  three  degrees 
less  fever  the  next  morning.  It  had  been  treated  in  the  evening. 
In  a  case  in  which  the  temperature  was  103  degrees,  the  tempera- 
ture, pulse,  and  respiration  became  normal  in  five  days.  It  is 
true  that  cases  vary  naturally,  yet  in  view  of  the  fact  that  Osier 
states  that  the  fever  persists  for  from  five  to  ten  days,  and  that 
after  its  fastigium  is  reached  (usually  within  a  few  hours)  it  re- 
mains remarkably  constant,  it  is  evident  that  osteopathic  work 
is  successful  to  a  marked  degree  in  bettering  the  case. 

The  PROGNOSIS  is  good  under  osteopathic  treatment. 

EXAMINATION  AND  TREATMENT  for  the  location  and  removal 
of  lesion  are  made  according  to  methods  considered  in  Part  I. 
In  beginning  the  treatment,  as  the  patient  finds  it  easy  to  lie  on 
the  sound  side,  the  muscles  and  deep  tissues  are  gently  but  thor- 
oughly relaxed  along  the  length  of  the  spine,  particularly  upon 
the  affected  side.  This  starts  vaso-motion  and  brings  a  sense 
of  relief  from  the  constriction  that  so  distresses  the  patient. 
During  this  treatment  upon  the  side,  treatment  is  given  the 
centers  for  bowels,  kidneys,  and  superficial  fascia  (2nd  dorsal 
and  oth  lumbar),  to  rouse  them  to  action  and  to  aid  in  the  elimi- 
nation of  poison  from  the  system. 

This  initial  treatment  has  thus  prepared  for  the  more  specific 


92  PRACTICE    OF    OSTEOPATHY. 

treatment  for  the  fever,  itself  being  part  of  the  process.  The 
next  step  consists  in  turning  the  patient  gently  upon  his  back 
and  thoroughly  relaxing  the  cervical  tissues,  the  tissues  behind 
the  clavicle  and  first  rib,  raising  the  clavicle  and  depressing  the 
first  rib,  after  relaxation  of  the  scaleni  muscles.  Treatment 
should  also  be  applied  to  the  course  of  the  vagi,  and  to  the  re- 
current laryngeal  nerves  at  the  lower,  inner  parts  of  the  sterno- 
mastoid  muscles.  In  these  ways  motor  power  to  the  lungs  is 
increased,  and  vaso-motion  is  corrected.  The  treatment  for 
fever  is  now  completed  by  steady  pressure  in  the  sub-occipital 
fossae  in  the  usual  way.  The  fever  is  not  likely  to  go  down  at 
once,  but  is  gradually  reduced  after  the  treatment,  for  some 
hours.  This  is  because  of  the  freedom  given  to  the  vaso-motors 
in  the  course  of  the  treatment,  and  the  gradual  change  now  being 
wrought  in  the  patient's  system  by  the  recuperated  forces. 

The  treatment  ,for  fever  may  be  aided  by  the  deep  inhibi- 
tive  treatment  to  the  abdomen,  before  described,  to  dilate  the 
immense  abdominal  veins  and  aid  in  calling  away  the  blood  from 
the  engorged  lung. 

Further  treatment  is  given  the  lungs,  with  the  patient  on 
the  back,  by  gently  elevating  the  ribs  from  the  second  to  the 
seventh  on  both  sides.  This  stimulates  the  vaso-motor  centers 
to  the  lungs.  Elevation  of  all  the  ribs  gives  much  relief  from 
tension,  and  is  the  specific  method  of  relieving  the  pain  in  the 
side. 

Stimulation  of  the  accelerators  of  the  heart,  second  to  fifth 
dorsal  on  the  left  side,  aids  in  circulation  through  the  lungs,  and 
stimulates  the  heart  against  failure.  "In  consolidation,  the 
right  ventricle  is  subjected  to  a  strain  and  there  is  danger  of  heart 
failure. " — (Stevens.) 

For  the  cough,  the  treatment  should  be  close  and  deep  along 
the  trachea  from  the  larynx  to  the  root  of  the  neck,  also  relaxa- 
tion of  the  anterior  tissues  of  the  chest,  including  the  upper  in- 
tercostal tissues.  The  middle  and  inferior  cervical  regions  should 
be  treated  for  the  lymphatics  to  the  lungs. 

The  amount  and  strength  of  the  treatment  must  be  regu- 
lated by  the  patient's  condition.  Strong  treatments  are  not 
allowed  on  account  of  weakness.  The  general  treatment  should 


PRACTICE    OF    OSTEOPATHY.  93 

be  given,  thoroughly  but  gently,  once  a  day  at  least.  The  pa- 
tient should  be  seen  three  or  four  times  per  day,  but  the  whole 
treatment  outlined  need  not  be  given  each  time.  A  little  treat- 
ment for  the  fever,  to  release  tension  over  the  lungs,  to  relieve 
pain  in  the  side,  etc.,  may  be  enough  at  a  time. 

Hygienic  precautions,  the  use  of  hot  applications,  foot  baths, 
rectal  injections,  etc.,  may  be  employed,  if  necessary.  The  pa- 
tient should  have  plenty  of  water  to  drink,  and  should  be  kept 
upon  a  liquid  or  semi-liquid  diet. 

PULMONARY  CONSUMPTION. 

DEFINITION:  Pulmonary  Consumption,  or  Tuberculosis  of 
the  Lungs,  is  a  destructive  disease  of  the  tissues  of  the  lungs, 
characterized  by  the  presence  of  the  bascillus  tuberculosis,  and 
caused  by  specific  lesions  in  the  upper  dorsal  and  thoracic  regions. 

CAUSES:  Cases:  (1)  In  a  case  of  "quick  consumption," 
acute  pneumonic  phthisis,  the'  upper  spine  was  swerved  to  the 
the  right;  the  2nd  dorsal  vertebra  was  lateral;  the  8th  and  9th 
dorsal  vertebra  lateral;  the  ribs  down,  narrowing  the  thoracic 
cavity. 

,(2)  Second  and  third  ribs  luxated;  marked  lesion  between 
the  corresponding  vertebrae,  and  the  tissues  about  them  very 
tender.  (3)  First,  second  and  third  left  ribs  down  and  in.  (4) 
Left  clavicle  down;  1st  to  8th  dorsal  vertebrae  flat;  8th  dorsal  to 
1st  lumbar  vertebras  posterior;  2nd  right  rib  tilted;  the  spine  and 
thorax  flat.  (5)  The  4th  dorsal  vertebra  sore;  3rd  to  5th  lumbar 
vertebrae  tight  and  irregular;  fifth  and  sixth  left  ribs  close  to- 
gether; first  rib  on  right  luxated;  all  ribs  down  and  irregular. 
(6)  First  to  fifth  right  ribs  lowered,  decreasing  the  capacity  of 
the  chest  and  interfering  with  the  vaso-motors  of  the  lungs 
through  their  spinal  connections. 

(7)  A  lateral  lesion  from  the  2nd  to  5th  dorsal,  and  a  drop- 
ping downward  of  the  ribs. 

(8)  A  lateral  curvature  of  the  upper  dorsal  spine,  the  2nd 
and  3rd  ribs  were  down,  and  the  muscles  of  the  neck  much  con- 
tractured. 

Lesions  are  often  found  of  the  2nd,  3rd  and  4th  ribs;  of 
the  5th,  6th,  7th  and  8th  ribs  (A.  T.  Still);  2nd  and  3rd  cervical 


94  PRACTICE    OF   OSTEOPATHY. 

vertebrae  usually  lateral,  and  lesions,  to  the  middle  and  inferior 
cervical  sympathetic  ganglia  affecting  the  lymphatics  of  the  lungs 
(McConnell);  of  the  clavicle. 

ANATOMICAL  RELATIONS:  In  these  cases  the  neck  lesion  is 
not  generally  of  prime  importance,  the  dorsal  lesion  being  the  par- 
ticular one,  and  of  this  variety,  that  more  especially  affecting 
the  upper  several  ribs.  Lesion  of  the  spine,  muscles,  ligaments, 
or  ribs,  as  low  as  the  10th  may  become  the  cause  of  the  disease. 
In  very  many  cases  the  lesion  will  be  found  to  involve  the  second 
dorsal  vertebra  or  the  second  rib. 

There  are  important  reasons  why  lesions  of  ribs  lead  to 
pulmonary  tuberculosis,  and  why  the  flattened  thorax,  charac- 
teristic of  the  disease,  is  so  closely  related  to  the  condition  either 
as  primary  lesion  causing  it,  or  as  a  lesion  secondary  to  it.  Ac- 
cording to  the  American  Text-book  of  Physiology,  stimulation 
of  intercostal  nerves  causes  reflex  constriction  of  pulmonary 
vessels.  The  intercostal  nerves  are  all  connected  directly  with 
the  sympathetic  system  by  rami  communicant es,  and  the  sympa- 
thetic vaso-dilator  and  vaso-constrictor  fibres  of  the  system  are 
situated  all  along  the  thoracic  spinal  region.  Luxations  of  ribs 
and  a  flattened  thorax  (dropped  ribs)  set  up  irritation  in  the  inter- 
costal nerves,  leading  to  a  constriction  of  the  pulmonary  ves- 
sels. A  vast  area  may  be  affected  through  the  wide  distribution 
of  intercostal  nerves.  Very  general,  or  localized,  anemia  of  lung 
tissues  follows  upon  pulmonary  vascular  constriction  caused  by 
this  over-stimulation  of  the  intercostal  nerves.  This  devitalizes 
the  tissues  of  the  lung,  and  gives  a  foot-hold  to  the  pathogenic 
bacteria,  held  by  medical  authorities  to  be  the  sole  cause  of  tuber- 
culosis. 

With  regard  to  the  microbic  origin  of  this  disease,  the  Osteo- 
path does  not  deny  the  presence  of  such  bacteria  in  the  lung,  nor 
their  activity  in  destruction  of  lung  tissue.  He  holds  that  there 
is  necessary  a  lesion  to  the  lung,  in  the  form  of  an  impediment 
to  proper  nerve  and  blood-supply  to  the  lung  tissues,  weakening 
them  to  an  extent  that  allows  the  bacteria,  which  cannot  grow 
in  healthy  tissues,  to  produce  their  kind  and  to  form  their  toxins. 

It  has  already  been  pointed  out  that  the  vaso-motor  spinal 
area  for  the  lungs  (2nd  to  7th  dorsal),  and  particularly  the  re- 


PRACTICE    OF   OSTEOPATHY.  .  95 

gion  of  the  2nd,  3rd,  and  4th  thoracic  sympathetic  ganglia,  is 
most  apt  to  suffer  from  lesion  in  diseases  of  the  lungs.  Rib, 
vertebral,  intercostal  or  spinal  muscular  lesion,  etc.,  is  more 
likely  to  cause  lung  disease  in  this  area  than  elsewhere.  It  is 
a  well  known  fact  that  the  apices  of  the  lungs  are  most  generally 
the  seat  of  the  disease.  This  fact  is  readily  explained  by  the 
fact  that  upper  rib  and  spinal  lesions,  most  frequent  in  consump- 
tion of  the  lungs,  affects  this  region  of  the  lung  generally,  center- 
ing upon  this  important  vaso-motor  area.  The  further  fact  that 
the  apex  of  the  lung  is  not  usually  so  well  developed  on  account 
of  lazy  habits  of  breathing,  makes  lesion  in  this  region  more 
important.  Anders  states  that  special  investigation  has  shown 
that  the  disease  does  not  begin  at  the  tip  of  the  apex,  but  about 
one  and  one-half  inches  below,  near  the  postero-external  border. 
Posteriorly  the  first  signs  are  discovered  over  the  lower  part  of 
the  supra-spinous  fossae;  anteriorly,  immediately  below  the  middle 
of  the  clavicle,  along  a  line  about  one  and  one-half  inches  from 
the  inner  ends  of  the  second  and  third  intercostal  spaces.  The 
starting  point  may  also  be  located  at  the  first  and  second  inter- 
costal spaces  below  the  outer  third  of  the  clavicle.  These  points 
of  origin  of  this  disease  in  the  lung  are  thus  in  the  close  relation 
with  those  upper  ribs  apparently  most  often  luxated  in  this 
disease.  In  this  way  the  osteopathic  view  that  such  lesion  causes 
the  disease  is  supported  by  the  facts. 

PROGNOSIS:  Except  in  late  and  serious  stages  of  the  dis- 
ease, the  chances  of  limiting  its  progress  are  good.  Some  cases 
may  be  cured.  The  prognosis  as  to  recovery,  however,  must  be 
guarded.  In  many  cases  much  may  be  done  for  the  benefit  of 
the  patient's  general  health. 

TREATMENT:  The  first  consideration  is  the  removal  of  the 
specific  lesion  causing  the  trouble.  This  is  accomplished  by 
methods  already  given.  The  removal  of  lesion  has  been  followed 
by  recovery.  Thorough  spinal  treatment  should  be  given  for 
the  correction  and  upbuilding  of  the  vaso-motor  activities.  The 
spinal  muscles  and  deep  tissues  should  be  relaxed,  and  the  ribs 
should  be  raised  to  allow  the  greatest  area  of  expansion  possible. 
The  vaso-motor  area  for  the  lungs  should  receive  especial  treat- 
ment. In  all  these  ways  the  blood-supply  to  the  lungs  is  upbuilt. 


96  PRACTICE    OF    OSTEOPATHY. 

This,  next  to  the  removal  of  lesion,  is  the  main  consideration  in 
the  treatment  of  the  case.  Phagocytici  activity  is  said  to  con- 
stitute the  natural  power  of  resistance  of  the  system  to  the  bas- 
cilli.  By  increasing  blood-supply  to  the  tissues,  phagocytic 
activity  is  increased,  the  tissues  are  strengthened,  and  the  en- 
croachments of  the  bacteria  are  limited.  As  they  cannot  live  and 
propagate  in  healthy  tissues,  and  as  pure  blood  is  a  germicide, 
the  progress  of  the  disease  is  checked  as  soon  as  pure  blood  and 
healthy  tissue  are  opposed  to  them  in  equal  ratio.  Thorough 
stimulation  of  the  functions  of  heart  and  lungs  materially  aids 
this  process.  The  very  important  nerve-connections  of  the 
lungs,  already  pointed  out  in  detail,  afford  the  Osteopath  the 
surest  means  of  reaching  this  result.  His  is  the  natural  method. 
Strong  lungs  remain  immune  to  this  disease  because  healthy 
tissues  will  not  harbor  the  microbe.  Consumptives  have  been 
cured  by  judicious  exercise,  fresh  air,  and  careful  regimen.  In 
this  way  the  tissues  of  the  lung  have  been  built  up,  the  circula- 
tion to  it  has  been  increased,  and  the  bacteria  have  been  crowded 
out  by  the  gain  over  them  of  the  natural  healthy  processes  thus 
aroused.  Osteopathy  removes  the  impediment  to  normal  activ- 
ities of  the  blood  and  nerve-forces  that  make  strong  lung  tissue. 
Its  method  does  that  which  Nature  unaided  could  not  do,  and 
further  aids  Nature  to  recover  from  weakness  caused  by  the 
disease.  No  other  method  would  seem  more  sure  of  success  than 
this. 

The  clavicles  should  be  raised,  and  the  pneumogastric, 
phrenic,  and  cervical  sympathetic  nerves  should  be  freed  and 
toned  for  reasons  already  explained.  Fresh  air,  judicious  ex- 
ercise, and  nutritious  diet  are  indispensable  factors  in  the  treat- 
ment. Antiseptic  precautions  in  regard  to  the  patient's  sputum, 
linen,  etc.,  should  be  observed.  Bowels,  kidneys,  and  skin  should 
be  stimulated  to  full  activity.  General  circulation  must  be  in- 
creased. 

The  night  sweats  generally  soon  yield  to  the  spinal  treat- 
ment. The  cough  may  be  relieved  by  treatment  along  the 
trachea  and  anterior  thorax,  but  it,  as  well  as  the  expectoration, 
fever,  and  hemorrhages,  are  relieved  and  checked  by  the  favor- 
able progress  of  the  case.  The  greatest  care  must  be  taken  for 


PRACTICE    OF    OSTEOPATHY.  97 

the  patient's  general  condition  and  nutrition. 

Treatment  is  given  in  the  ordinary  chronic  case  three  times 
per  week.  In  the  acute  form  it  should  be  given  daily. 

The  modern  method  of  having  the  patient  live  entirely,  or 
practically  so,  in  the  open  air  is  a  most  valuable  means  of  fighting 
the  disease. 

CONGESTION  OF  THE  LUNGS. 

DEFINITION:  A  vaso-motor  disturbance  of  the  lungs,  re- 
sulting in  engorgement  of  the  blood-vessels,  and  caused  by 
lesions  in  the  upper  dorsal,  thoracic,  and  cervical  regions. 

The  lesions  producing  this  disease  may  be  any  of  the  lesions 
interfering  with  the  innervation,  especially  vaso-motor,  and  with 
the  blood-supply  to  the  lungs.  These  have  been  described  in 
the  discussion  of  the  different  diseases  of  the  lungs  already  con- 
sidered, q.  v.  With  these  lesions  present  and  weakening  the  cir- 
culatory energy  in  the  lungs,  some  direct  exciting  cause,  such  as 
exposure,  over-exertion,  and  the  like,  may  bring  on  the  attack. 
In  the  passive  forms  of  congestion,  secondary  to  enfeebled  heart 
action  or  to  valvular  disease,  or  coming  on  through  stasis  of 
blood  due  to  a  long  continued  dorsal  position  of  the  patient, 
also  in  the  active  form  of  pulmonary  congestion,  when  the  trouble 
may  be  symptomatic  of  pneumonia,  pleurisy,  etc.,  the  lesion 
must  be  investigated  with  regard  to  the  actual  disease,  and  may 
be  but  in  part  responsible  directly  for  this  condition. 

The  PROGNOSIS  is  good,  numerous  cases  are  treated  with 
marked  success. 

The  TREATMENT  must  be  directed  at  once  to  the  removal 
of  the  specific  lesion  if  possible.  The  main  object  of  the  treat- 
ment is  to  gain  vaso-motor  control.  As  soon  as  the  impeded 
circulation  is  released,  and  activity  restored  to  the  innervation 
of  the  vessels,  further  progress  of  the  disease  is  prevented.  As 
in  the  first  stage  of  pneumonia  the  disease  was  aborted  by  gain- 
ing vaso-motor  control  of  the  parts,  so  here  the  whole  matter 
rests  upon  the  correction  of  the  circulation.  The  accelerators 
of  the  heart,  2nd  to  5th  dorsal  on  the  left,  and  the  vaso-motors 
of  the  lungs,  2nd  to  the  7th  dorsal,  should  be  stimulated  at  once, 
and  the  treatment  gives  immediate  relief  from  the  dyspnea. 
Often  the  patient  is  sitting  up  in  the  effort  to  get  air,  and  the 


98  PRACTICE    OF    OSTEOPATHY. 

practitioner  may  easily  stand  behind  and  thoroughly  treat  the 
upper  dorsal  region,  releasing  contractured  muscles,  stimulating 
the  centers  mentioned,  and  raising  the  ribs.  Pressure  with  the 
knee  upon  the  back,  while  the  arms  are  both  raised  high  above 
the  head,  expands  the  chest,  draws  the  air  into  the  lungs,  and 
aids  in  restoring  circulation.  This  work  also  aids  the  process 
by  increasing  activity  in  intercostal  vessels  and  nerves.  The 
latter  should  be  thoroughly  treated  along  the  spine,  intercostal 
spaces,  and  over  the  chest  anteriorly,  as  stimulation  of  the  in- 
tercostal nerves  has  been  shown  to  cause  reflex  constriction  of 
the  pulmonary  vessels.  Treatment  should  be  given  the  pneumo- 
gastric  nerves,  and  any  cervical  lesion  to  them  be  removed,  on 
account  of  their  participation  in  the  pulmonary  plexus.  Treat- 
ment at  the  superior  cervical  region  for  general  vaso-motor  effect, 
and  in  the  abdominal  region  to  call  tbe  blood  away  from  the 
lungs,  will  aid  in  the  case.  Turpentine  stupes  applied  to  the 
chest  over  the  affected  areas  are  a  great  aid.  In  cases  of  hypo- 
static  congestion  the  patient's  position  in  bed  must  be  changed 
so  as  to  drain  the  blood  from  the  parts  affected,  usually  the  pos- 
tero-inferior. 

Patients  are  usually  relieved  immediately  upon  treatment, 
The  dyspnea  being  most  easily  relieved.  The  cough  and  bloody 
expectoration  gradually  subside  with  the  betterment  of  the 
case,  which  quickly  yields  to  treatment.  One  or  a  few  treat- 
ments ordinarily  correct  the  condition. 

EDEMA  OF  THE  LUNGS. 

DEFINITION  :  A  condition  in  which  there  is  transudation 
of  the  serum  of  the  blood  from  the  vessels  into  the  aveoli,  bronchi, 
and  sometimes  into  the  interstitial  tissues  of  the  lungs. 

Cases  are  commonly  met  as  complications  of  other  diseases, 
as  of  heart,  lungs,  etc. 

LESIONS  AND  ANATOMICAL  RELATIONS:  As  this  condition 
is  generally  secondary  to  lung,  heart,  kidney,  or  other  disease, 
the  lesions  would  be  those  responsible  for  the  primary  disease. 

Local  lesion  may  be  the  cause  of  the  condition.  As  it  is 
pointed  out  that  generalized  edema  of  the  lungs  may  be  due  to 
any  of  the  causes  producing  active  or  passive  congestion  of  the 
lungs,  those  lesions  already  described  as  interfering  with  vaso- 


PRACTICE    OF    OSTEOPATHY.  99 

motor  and  motor  activities  of  the  lungs  would  be  sufficient  to 
cause  it.  The  general  lesions,  and  their  anatomical  relations, 
which  interfere  with  the  pulmonary  innervation  and  circulation 
have  been  fully  discussed.  Circumscribed  edema  may  result 
from  localized  disturbance  of  the  blood-supply,  due  to  the  effects 
of  a  certain  localized  lesion.  "Obstruction  to  the  aorta  may 
cause  it"  (Anders.) 

It  must  be  borne  in  mind  that  lesion  to  the  vagus  nerve 
interferes  with  muscular  motion  in  •  the  lungs  and  favors  con- 
gestive, and  inflammatory  conditions,  and  may  lead  to  edema. 
Lesions  in  the  vaso-motor  area  (2nd  to  7th  dorsal,)  and  the  vari- 
ous rib,  clavicular,  and  other  lesions  affecting  the  lungs  may 
cause  this  trouble.  Eichhorst  shows  that  disturbances  of  the 
innervation  of  the  pulmonary  vessels  may  cause  it,  and  it  is 
probable  that  the  increased  permeability  of  the  vessel  walls 
which  allows  of  the  transudation  of  serum  is  directly  due  to  the 
lesions  to  the  vaso-motors.  Anders  describes  the  condition  as  a 
"disturbance  of  cardio-pulmonic  innervation."  Such  disturb- 
ances are  well  known  to  be  the  result  of  various  bony  lesions. 

The  PROGNOSIS  must  be  guarded,  especially  in  those  acute 
cases  complicating  other  diseases,  as  in  cardiac  and  renal  dropsy. 
In  the  chronic  and  recurring  forms  the  prognosis  is  more  favor- 
able. The  prognosis  must  usually  depend  upon  that  for  the  pri- 
mary disease.  ) 

It  is  often  symptomatic  of  approaching  death. 

TREATMENT  includes  that  for  the  primary  disease,  accord- 
ing to  its  kind.  In  any  case  the  main  object  is  to  remove  all 
obstruction  to  free  circulation  throughout  the  lungs.  To  this 
end  the  heart  and  the  vaso-motor  area  for  the  lungs  should  be 
kept  well  stimulated. 

Any  lesion  present  must  be  removed  as  soon  as  possible. 

With  renewed  activity  of  the  circulation  and  increased 
tone  of  the  vessels  the  further  progress  of  the  trouble  is  limited, 
'  and  the  absorption  of  the  exudate  is  favored.  Now  the  kidneys, 
bowels,  and  skin  should  be  kept  active  by  thorough  treatment. 
It  has  been  shown  in  dropsical  cases  that  the  kidneys  may  be 
aroused,  by  the  treatment,  to  enormous  activity. 

The  spinal  and  intercostal  muscles  should  be  relaxed  and 


100  PRACTICE    OF    OSTEOPATHY. 

the  ribs  should  be  well  raised  to  relieve  the  dyspnea.  The  ex- 
pectoration, due  to  the  accumulation  of  fluid  in  the  alveoli  and 
bronchi,  is  relieved  by  the  general  process  of  the  treatment,  and 
by  the  increased  circulation  particularly. 

A  general  spinal  and  cervical  treatment,  with  flexion  of 
the  thighs,  abdominal  stimulation,  etc.,  should  be  given  to  keep 
the  general  circulation  active  and  thus  to  call  away  the  congested 
blood  from  the  lungs.  For  the  same  purpose  treatment  should 
be  given  over  the  sternum  and  ribs  anteriorly. 

In  severe  acute  stages  one  must  be  continually  on  guard 
against  an  emergency.  In  urgent  situations  it  is  necessary  to 
take  quick  and  vigorous  measures.  In  such  situations  the  regu- 
lar osteopathic  measures  are  greatly  aided  by  the  use  of  cafe  noir, 
or  by  the  application  of  hot  sponges  or  hot  mustard-plasters  to 
the  chest. 

PULMONARY-  HEMORRHAGE. 

I.  BRONCHO-PULMONARY    HEMORRHAGE;    HEMOPTYSIS. 

II.  PULMONARY  APOPLEXY;  HEMORRHAGIC  INFARCT. 

CASES:  (1)  A  young  married  woman,  five  months  preg- 
nant; daily  hemorrhage  from  the  lungs  for  nearly  a  week.  Had 
had  similar  attacks  5  months  before.  They  were  due  to  con- 
gestion of  the  lung  tissue.  Lesions  were  found  in  the  form  of  a 
sensitive  upper  dorsal  spine,  with  contracture  of  the  scapular, 
cervical,  and  intercostal  muscles.  Treatment  of  the  lesions 
caused  rapid  improvement. 

(2)  Hemoptysis  in  a  case  of  bronchial  disease;  lesion  as  a 
lateral  curvature  of  the  spine,  and  lesion  at  the  3rd  dorsal  ver- 
tebra. The  case  was  treated  successfully.  Cases  of  hemoptysis 
as  a  complication  of  pulmonary  tuberculosis,  its  commonest 
cause,  are  frequently  treated  with  success. 

DEFINITION:  Broncho-Pulmonary  Hemorrhage,  or  Hem- 
optysis, is  a  condition  due  to  bleeding  into  the  bronchus,  whence 
the  blood  is  coughed  up  and  expectorated. 

Pulmonary  Apoplexy,  or  Hemorrhagic  Infarct  is  a  condi- 
tion in  which  the  bleeding  takes  place  into  the  air-cells  and  lung- 
tissue.  It  may  be  diffuse  (rare)  or  circumscribed.  The  former 


PRACTICE    OF    OSTEOPATHY.  101 

is  more  copious.  The  latter  is  usually  due  to  embolism,  and  is  a 
true  hemorrhagic  infarct. 

LESIONS:  There  are  commonly  present  lesions  of  spine, 
-ribs,  cervical  tissues,  spinal  tissues,  etc.,  affecting  the  area  of 
innervation  of  the  lung.  These  occur  largely  between  the  2nd 
and  7th  dorsal,  at  the  clavicle,  among  the  upper  ribs,  or  in  the 
cervical  region  upon  the  vagus  nerves,  weakening  the  lung  and 
laying  it  liable  to  the  action  of  the  numerous  causes  that  may 
result  in  pulmonary  hemorrhage.  The  various  lesions  that  may 
affect  the  circulation  and  innervation  of  the  lungs,  and  the  ana- 
tomical relations  of  such  lesions  to  the  lungs,  have  been  pointed 
out.  Almost  any  of  these  various  lesions  may  result  in  deranging 
the  vaso-motor  state  of  the  lungs,  either  by  directly  affecting 
-the  vaso-motor  nerves,  or  indirectly,  by  weakening  the  lung- 
function  and  impairing  the  nutrition  of  the  tissues  and  vessels. 

Consumption,  q.  v.  offers  a  good  illustration  of  the  effects 
of  lesion  to  the  lungs  resulting  in  a  disturbed  vaso-motor  con- 
.dition  which  results  in  hemorrhage.  Here,  in  the  early  stages, 
the  hemorrhage  is  due  to  a  congestion  of  the  membrane  lining 
the  small  bronchi.  So  any  lesion  weakening  the  vessels  and 
leading  to  congestion  of  the  lungs  may  result  in  hemorrhage. 

In  cases  in  which  the  hemorrhage  is  secondary,  as  in  heart- 
disease,  pneumonia,  bronchitis,  ulcers,  etc.,  the  lesion  must  be 
looked  for  as  causing  the  primary  disease. 

The  PROGNOSIS  must  be  guarded.  Hemorrhage  from  the 
lungs  is  commonly  a  grave  occurrence.  In  some  cases  it  is  of 
but  little  consequence.  A  fair  number  of  cases  are  handled  suc- 
cessfully by  Osteopathy.  The  prognosis  is  favorable  in  cases 
due  to  consumption  in  its  first  stages,  pulmonary  congestion, 
pneumonia,  fibrinous  bronchitis,  some  forms  of  heart-disease, 
anemia,  etc.  It  is  grave  in  the  later  stages  of  pulmonary  tuber- 
culosis, in  rupture  of  an  aneurism,  in  some  forms  of  heart-dis- 
ease, etc. 

TREATMENT : 

I.  IN  HEMOPTYSIS:  Here  the  first  indication  is  to  keep 
the  patient  quiet,  bodily  and  mentally.  He  should  remain  in 
bed.  In  cases  due  to  a  congestive  condition  of  the  bronchial 


102  PRACTICE    OF   OSTEOPATHY. 

mucous  membrane,  the  main  thing  is  to  keep  the  patient  quiet 
in  this  way. 

A  valuable  osteopathic  treatment  in  all  such  cases  is  inhi- 
bition of  the  heart.  This  is  accomplished  by  continuous  inhi- 
bitive  pressure  from  the  2nd  to  5th  dorsal.  It  meets  the  important 
requirement  of  decreasing  the  power  of  the  heart's  contractions. 

This  inhibition  may  be  carried  down  over  the  lung  area  and 
over  the  splanchnics,  thus  decreasing  the  vascular  tonus  in  the 
lungs,  and  in  the  vessels  of  the  splanchnic  area.  This  object  is 
aided  by  deep,  inhibitive  abdominal  work,  dilating  the  abdom- 
inal veins,  and  calling  the  blood  away  from  the  lungs.  The 
general  vaso-motor  center  in  the  medulla  should  be  inhibited, 
by  pressure  in  the  sub-occipital  fossae.  In  all  these  ways  one 
quiets  the  circulation,  slows  the  blood-flow,  and  favors  the  for- 
mation of  clots  to  stop  the  hemorrhage.  This  line  of  treatment 
likewise  meets  the  important  requirement  of  confining  the  blood 
to  the  systemic  circulation. 

One  should  avoid  percussion,  as  it  may  increase  the  hem- 
orrhage. The  fever  should  be  treated  in  the  usual  way,  but  it 
is  not  a  troublesome  •  symptom  usually.  All  the  upper  spinal 
muscles  and  tissues,  as  well  as  those  of  the  cervical  region,  and 
the  intercostal  muscles,  should  be  carefully  relaxed  in  order  to 
remove  any  irritating  tension  from  the  lungs.  This  treatment 
will  aid  in  relieving  the  cough,  but  it  must  be  carried  out  very 
gently,  in  order  not  to  move  the  chest  or  ribs,  as  thereby  the  clots 
might  be  broken  and  the  hemorrhage  increased. 

Any  lesion  present  may  usually  be  left  for  treatment  until 
after  the  hemorrhage  is  fully  controlled,  as  the  handling  of  the 
patient  in  repairing  it  would  be  likely  to  start  the  hemorrhage. 
Later  a  thorough  course  of  treatment  should  be  devoted  to  them. 

The  patient  may  eat  ice  and  use  iced  drinks,  but  hot  drinks 
and  alcoholics  must  be  avoided.  The  diet  should  be  light  and 
non-stimulating.  In  congestive  conditions  hot  foot  baths  are 
useful.  Cold  applications  to  the  chest  may  be  used.  "A  firm 
ligature  about  one  or  both  legs  retards  the  flow  of  venous  blood 
and  aids  in  stopping  the  hemorrhage." — (Stevens.)  In  severe 
cases  no  salt  or  fluids  should  be  allowed.  It  is  sometimes  neces- 
sary to  withhold  food  entirely  for  a  time. 


PRACTICE    OF    OSTEOPATHY.  103 

After  the  emergency  due  to  the  hemorrhage  has  been  safely 
met,  and  the  patient  has  recovered  sufficiently  to  undergo  a 
course  of  treatment,  attention  should  be  given  to  the  underlying 
condition  of  the  system  responsible  for  the  hemorrhage.  The 
gout,  suppressed  menstruation,  heart  affection,  anemia,  etc., 
must  be  treated  as  the  circumstances  require.  Of  course  many 
cases,  in  which  the  hemorrhage  does  not  become  severe  enough 
to  be  considered  an  emergency,  fall  at  once  into  this  category. 

II.  In  pulmonary  apoplexy  one  may  follow  the  same  .line 
of  treatment  largely,  especially  at  the  time  of  hemorrhage.  The 
patient  must  have  absolute  rest,  etc.,  as  described  above. 

In  the  diffuse  pneumorrhagia,  where  the  hemorrhage  is 
usually  copious,  the  case  is  generally  hopeless,and  rest  is  the 
only  measure  necessary.  The  cases  are,  fortunately,  rare. 

In  the  circumscribed  form  (pulmonary  infarction)  the  in- 
dications at  the  time  of  the  hemorrhage  are  the  same  as  above. 
The  syncope,  dyspnea,  pain  in  the  side,  cough,  and  convulsions 
will  be  relieved  by  these  measures. 

Later  indications  are  to  repair  lesion,  build  up  the  strength 
of  the  lung,  keep  the  local  circulation  active  and  absorb  the  clot. 
This  will  prevent  the  formation  of  abscess  or  gangrene,  at  the 
point  of  infarction. 

EMPHYSEMA. 

DEFINITION:  Alveolar  Emphysema  is  a  condition  in  which 
air  is  retained  in  the  aveoli,  distending  them,  leading  to  atrophy 
of  the  elastic  tissue  in  their  walls,  and  to  destruction  of  the  septa 
between  the  alveoli.  It  may  be  localized,  unilateral  or  bilateral. 
It  is  conpensatory  when  occuring  from  overwork  of  one  lung, 
or  a  portion  of  it,  by  disability  of  the  rest,  and  may  then  be  re- 
garded as  an  hypertrophy;  it  is  essential  when  involving  most 
of  both  lungs.  SENILE  EMPHYSEMA  is  a  variety,  occurring  in  old 
people,  in  which  atrophy  and  destruction  of  the  alveolar  walls 
allows  of  the  formation  of  large  aii-sacs  by  the  coalesced  air-cells. 

Interstitial  Emphysema  is  a  form  in  which  air  escapes  into 
the  interalveolar  and  interlobular  connective  tissue. 

The  LESIONS  AND  ANATOMICAL  RELATIONS  before  observed 
in  lung-diseases  may  be  recalled  here. 


104  PRACTICE    OF    OSTEOPATHY. 

Various  rib  and  vertebral  bony  lesions,  contractures  of 
spinal  muscles,  etc.,  as  well  as  lesions  in  the  cervical  region, 
interfere  with  the  sympathetic  vaso-motor  and  trophic  inner- 
vation  of  the  lung,  weaken  its  tissues,  derange  its  blood-supply, 
or  interfere  with  its  motor  apparatus  in  such  a  way  as  to  lay  it 
liable,  (a)  to  diseases  which  result  in  emphysema,  or  (b)  to  dis- 
tention  of  tissues  from  weakness,  due  to  bad  trophic  conditions, 
upon  the  occasion  of  sudden  strain  put  upon  them  by  coughing 
or  other  strong  effort. 

Thus,  in  the  one  class  of  cases  the  lesion  would  pertain 
more  particularly  to  the  primary  disease.  The  bony  lesion  causing 
bronchial  asthma  by  irritating  the  vagus  nerve  and  causing 
spasmodic  contraction  of  the  bronchioles,  or  that  causing  a 
vaso-motor  derangement  resulting  in  catarrhal  swelling  of  the 
mucous  membrane  of  the  bronchioles,  thus  obstructing  the  exit 
.of  the  air  from  the  alveoli,  is  the  underlying  cause  of  the  emphy- 
sema. 

In  the  other  class  the  lesion  is  more  directly  responsible  for 
the  condition. 

These  cases  frequently  come  under  our  treatment,  most 
commonly  as  a  complication  of  asthma  or  bronchitis. 

The  PROGNOSIS  is  favorable  in  that  the  patient's  life  may 
be  made  comfortable  and  be  prolonged.  The  conditions  re- 
sulting from  emphysema  may  be  modified  or  prevented. 

The  condition  is  incurable  because  it  is  impossible  to  re- 
store the  elasticity  of  the  lung  tissue  or  the  destroyed  septa. 

Great  improvement  in  the  patient's  condition  is  accom- 
plished by  the  treatment. 

In  the  interstitial  form  absorption  of  the  air  in  the  tissues 
may  take  place,  the  case  thus  recovering.  In  cases  of  acute  in- 
flation the  prognosis  is  good. 

The  TREATMENT  looks  at  once  to  the  removal  of  the  lesions 
present,  and  to  the  relief  of  the  primary  disease,  whatever  it 
is.  The  vaso-motor  area  (2nd  to  7th  dorsal)  should  be  kept 
well  stimulated  to  increase  the  circulation.  This  is  especially 
necessary  because  of  the  compression  or  destruction  of  the  cap- 
illary networks  about  the  alveoli  in  the  affected  portions.  It 
also  aids  in  restoring  strength  to  the  tissues,  and  in  correcting 


PRACTICE    OF    OSTEOPATHY.  105 

the  catarrhal  condition  of  the  bronchi  so  likelyto  result  from  this 
disease.  Stimulation  of  the  vagi  is  important  for  the  purpose 
of  increasing  the  motor  power  in  the  lungs.  The  ribs  should 
all  be  raised  to  give  the  lungs  free-play,  and  likewise  the  spinal 
and  intercostal  muscles  should  be  relaxed,  the  clavicles  raised, 
and  the  sternum  and  cartilages  be  well  treated. 

It  is  important  to  keep  the  heart  well  stimulated  to  guard 
against  venous  stasis  and  its  results,  which  are  the  most  to  be 
feared.  Eichhorst  mentions  rhythmic  compression  of  the  thorax 
in  these  cases.  Treatment  to  raise  the  ribs  in  inspiration  and 
to  compress  them  in  expiration  may  be  used  with  profit. 

In  these  ways  danger  of  death  from  stasis  or  suffocation 
is  minimized.  The  patient's  general  health  should  be  built  up. 
In  these  cases  hypertrophy  of  the  right  heart  usually  results. 
The  patient  must  avoid  dust,  bad  air,  and  exertion.  In  emergen- 
cies mustard  plasters  to  the  chest  and  hot  foot-baths  are  good. 
The  patient  must  be  continually  guarded  against  heart  failure, 
which  is  likely  to  result  from  acute  dilatation  of  the  right  ven- 
tricle. 

ACUTE  NASAL  CATARRH,  OR  CORYZA,  AND  COLDS. 
CHRONIC  NASAL  CATARRH. 

RHINITIS,  ACUTE  AND  CHRONIC. 

DEFINITION:  Acute  Nasal  Catarrh  is  an  inflammation  of 
the  nasal  mucous  membranes,  accompanied  by  an  increased 
secretion  of  mucus  and  by  various  general  symptons,  and  is 
caused  by  specific  lesions,  in  the  cervical  region  chiefly,  which 
may  be  secondary  to  contractures  of  muscles  and  soft  tissues  by 
exposure.  After  repeated  attacks  the  disease  becomes  chronic, 
upon  account  of  the  confirmed  condition  of  the  lesions. 

A  "cold  in  the  head"  is  an  acute  attack  of  this  disease. 
Yet  "colds"  may  settle  in  any  part  of  the  body,  as  a  rule,  in 
f'the  weakest  part,"  and  then  probably  assume  the  form  of 
congestion  instead  of  inflammation  as  in  the  case  of  coryza. 
Its  manifestations  are  various,  one  of  the  chief  ones  being  the 
disturbed  vaso-motor  reflexes  of  the  body.  These  weak  places 
liable  to  such  congestion  are  commonly  due  to  lesion  of  the  part, 


106  PRACTICE    OF    OSTEOPATHY. 

which  acts  to  deteriorate  its  vitality  and  lessen  its  resistance 
power. 

CASES:  (1)  A  very  severe  and  distressing  cold,  to  sudden 
attacks  of  which  the  patient  was  subject.  They  came  on  sud- 
denly, lasted  nearly  a  week,  and  then  gradually  disappeared. 
Marked  coryza,  lachrymation,  and  sneezing  continually,  were 
features  of  the  case.  It  stimulated  hay-fever  very  closely. 
Upon  treatment  the  sneezing  stopped  almost  immediately. 
Treatment  was  to  the  vaso-motor  control  of  general  circulation, 
to  the  pulmonary  circulation,  to  relaxation  of  contractured 
muscles  of  cervical  and  upper  dorsal  regions,  and  to  the  circula- 
tion to  the  head. 

(2)  Sneezing  and  coryza,  with  all  the  common  symptoms 
of  "  catching  cold"  were  relieved  at  once  by  a  treatment.     Marked 
lesion  was  present  at  the  2nd  cervical  vertebra. 

(3)  Intense  nasal  catarrh  in  a  debilitated  system  suffering 
from  a  complication  of  diseases  yielded  at  once  to  the  treatment. 
After  six  week's  treatment  a  cold  contracted  from  exposure  was 
well  withstood. 

(4)  A  case  of  nasal  catarrh  in  a  debilitated  system  showing 
various  spinal  lesions  was  greatly  relieved  by  three  treatments, 
and  was  progressing  satisfactorily  under  treatment. 

Very  numerous  cases,  many  of  them  in  an  aggravated  con- 
dition come  constantly  under  treatment.  The  author  has  treated 
several  individuals  who  were  subject  to  very  severe  colds,  in 
whom  one  treatment  invariably  broke  up  the  most  severe  attack. 

One  case  of  chronic  catarrh  would,  soon  after  a  treatment, 
begin  to  spit  out  catarrhal  concretions  which  had  formed  in  the 
Eustachian  tubes. 

CAUSES:  The  specific  lesions  causing  such  disease  are,  as 
a  rule,  high  up  in  the  cervical  region,  effecting  especially  the 
1st  to  3rd  cervical  vertebrae,  but  they  may  occur  as  low  as  the 
sixth  dorsal.  One  of  the  chief  forms  of  lesion  is  that  of  contrac- 
ture  of  the  cervical  muscles  and  deep,  soft  tissues.  These  con- 
tractures,  due  primarily  to  exposure,  gradually  act  to  warp,  or 
draw,  the  cervical  vertebrae  and  intervertebral  discs  out  of  shape 
and  out  of  their  normal  anatomical  relations.  The  result  is  ob- 
struction to  blood  and  nerve-supply,  causing  chronic  catarrh. 


PRACTICE    OF   OSTEOPATHY.  107 

The  deeper  anatomical  lesions  due  to  contracture  and  to  other 
causes  as  well,  produce  catarrh,  and  not  some  other  disease,  be- 
cause of  affecting  certain  areas  of  nerve-connections  and  certain 
centers.  Thus  lesions  of  the  upper  three  cervical  vertebrae  act 
upon  the  superior  cervical  ganglion,  in  ways  already  discussed, 
and  disturb  the  fifth  nerve  through  its  very  intimate  connec- 
tions with  the  ganglion  in  question.  In  the  same  way,  lesion  to 
the  inferior  cervical  or  upper  dorsal  bony  parts  may  affect 
those  sympathetic  fibers  (or  the  area  of  the  cord  giving  origin  to 
them)  which  ascend  in  the  cervical  sympathetic  chain,  finally  to 
reach  the  fifth  nerve,  which  thus  supplies  secretory  fibers  to  the 
parts  in  question.  The  very  numerous  vaso-motor,  secretory 
and  trophic  fibers  for  all  parts  oT  the  head  and  face ;  for  salivary 
glands,  eye,  ear,  tongue,  face,  mouth,  etc.,  etc.,  passing  to  their 
points  of  distribution  through  various  of  the  cranial  nerves,  quite 
generally  arise  in  the  upper  dorsal  and  cervical  cord,  having  also 
numerous  connections  with  the  cervical  sympathetics.  This  mat- 
ter has  been  fully  discussed  in  another  place.*  This  explains  the 
importance  of  cervical  and  upper  dorsal  lesions.  Thus  lesions  low 
down  act  upon  the  ascending  fibers  of  nerve-supply  and  affect  a 
part  much  above,  as  in  the  case  of  dorsal  lesion  here. 

The  fifth  nerve  bears  special  mention  in  these  cases  as  the 
one  concerned  in  the  headache,  lachrymation,  sneezing,  secretion 
of  mucous,  and  inflammation  of  membranes.  This  nerve  is  also 
in  part  concerned  in  the  loss  or  alteration  of  the  functions  of 
taste  and  smell,  caused  by  pressure  of  the  injected  membranes 
upon  the  fine  nerve-terminals. 

The  PROGNOSIS  is  good  for  all  forms  of  the  disease.  In 
acute  cases  it  is  particularly  so,  as  one  or  a  few  treatments  usually 
end  the  symptoms.  In  chronic  catarrh  good  results  are  generally 
easily  attained,  and  many  times  a  cure  is  effected.  Unfavorable 
climates  do  much  to  prevent  cure  as  the  patient  is  constantly 
exposed,  hence  the  best  results  are  attained  in  the  favorable 
seasons  of  the  year. 

The  EXAMINATION  AND  TREATMENT  for  the  specific  lesion  is 
made  according  to  directions  in  Chaps.  I  to  VII.  The  specific 
lesion  should  be  treated,  and  removed  at  once  if  possible.  This 
applies  to  both  acute  and  chronic  cases.  In  acute  cases  one  of 


108  PRACTICE    OF    OSTEOPATHY. 

ihe  first  steps  is  to  relax  all  the  upper  dorsal  and  cervical  tissues. 
A  thorough  spinal  treatment  tones  all  the  vaso-constrictors 
(2nd  dorsal  to  2nd  lumbar),  and  all  the  vaso-dilators  (all  along 
the  spine),  thus  aiding  to  equalize  circulation,  and  reduce  con- 
gestion of  parts  concerned. 

This  effect  is  aided  in  an  important  way  by  raising  all  the 
Tibs,  and  particularly  by  treating  all  the  2nd  to  7th  dorsal  region 
on  both  sides,  in  this  way  increasing  the  activities  of  heart  and 
lungs.  The  anterior  thoracic  region  is  treated  to  relax  tissues 
/and  replace  ribs;  the  clavicle  is  raised,  and  separated  from  the 
first  rib  to  relax  the  deep  anterior  cervical  tissues,  to  free  circu- 
lation through  the  carotid  arteries  and  jugular  veins,  and  to  free 
the  pneumogastric  nerves.  All  the  cervical  muscles  are  thor- 
oughly relaxed,  the  ligaments  released  by  deep  treatments,  and 
the  vertebrae  of  the  whole  region  manipulated.  This  frees  the 
connections  of  the  sympathetics,  the  venous  flow  from  the  head, 
/and  tone?  vaso-motion  in  the  affected  parts.  It  is  an  important 
-step  in  remedying  the  congestion  of  the  parts  of  the  head.  In- 
hibitive  treatment  should  be  given  the  superior  cervical  ganglion 
to  dilate  blood-vessels  and  allow  the  congestion  to  be  swept  out. 
The  superior  and  inferior  hyoid  muscles  are  relaxed,  and  the  work 
is  carried  down  along  the  trachea  to  the  root  of  the  neck.  The 
mouth  is  opened  against  resistance ;  the  tissues  beneath  the  angles 
of  the  jaws  are  relaxed.  This  releases  the  internal  jugular  veins, 
stimulates  circulation  through  the  carotid  arteries,  and  corrects 
-circulation.  One  of  the  most  efficient  measures  for  curing  the 
-congestion  of  the  head,  and  to  relieve  the  stoppage  of  the  nos- 
trils is  the  momentary  pressure  upon  both  internal  jugular  veins, 
before  described,  followed  by  heavy  pressure  with  the  palms  of 
the  hands  upon  the  forehead. 

Particular  attention  is  devoted  to  the  treatment  of  the  fifth 
nerve  for  reasons  already  given.  It  is  reached  at  points  upon 
the  face  already  described,  and  all  the  tissues  over  them  are 
relaxed.  Treatment  of  this  nerve  thus  directly  is  a  most  im- 
portant adjunct  to  that  given  its  sympathetic  connections.  It 
is  most  important  as  a  means  of  relieving  the  inflammation, 
-secretion,  lachrymation,  and  stopping  of  the  nostrils.  Manip- 
ulation along  the  sides  of  the  nose  frees  the  nasal  ducts  and  re- 


PRACTICE    OF    OSTEOPATHY.  109' 

lieves  the  congestion;  strong  pressure  upon  the  root  of  the  nose 
and  upon  the  forehead  frees  the  nostrils;  tapping  over  the  frontal 
sinus  relieves  congestion  and  pain  in  it.  The  headache  is  relieved 
by  the  treatment  in  the  general  cervical,  superior  cervical,  and 
frontal  regions;  the  cough  is  relieved  by  the  treatment  along  the 
trachea;  the  chilly  feeling  by  the  brisk  spinal  treatment.  The 
soft  palate  may  be  treated  by  placing  the  finger  gently  upon  it 
and  sweeping  it  laterally  across.  This  treatment  may  be  carried 
well  up  toward  the  opening  of  the  Eusta'chian  tube.  The  con- 
gestion of  these  parts  is  thus  relieved. 

The  lungs  must  be  kept  well  treated  to  prevent  the  cold 
from  settling  upon  them.  Precautions  must  be  taken  against 
the  marked  tendency  of  these  congestions  to  move  from  part  to 
part.  This  is  done  by  keeping  all  well  stimulated  by  the  treat- 
ment. The  bowels  and  kidneys  are  treated  to  keep  their  action 
free.  The  treatment  about  the  lower  jaw  and  to  the  carotid 
arteries  is  efficient  in  reaching  the  Eustachian  tube,  and  in  loosen- 
ing the  secretions  that  sometimes  occlude  it.  Deep  treatment 
under  the  angles  of  the  jaws  is  good  in  all  forms  of  catarrh. 

In  chronic  cases  the  treatment  is  devoted  more  particularly 
to  the  removal  of  the  specific  lesion,  and  the  building  up  of  the 
blood-supply  to  the  nasal  membranes.  As  these  are  often 
atrophied  or  hypertrophied.  (Atrophic  or  Hypertrophic  Rhin- 
itis, Ozena.)  A  long  course  of  treatment  is  generally  necessary 
to  their  rehabilitation.  The  principal  treatment  is  directed  to- 
the  cervical  tissues,  where  chronic  contracture  of  the  muscles- 
exists. 

Daily  treatments  in  severe  acute  cases,  and  three  per  week 
in  chronic  cases,  are  usually  sufficient. 

The  patient  should  take  care  not  to  expose  himself,  but,, 
on  the  other  hand,  should  not  keep  the  body  tender  and  sus- 
ceptible by  dressing  too  warmly,  sleeping  under  too  many  covers,, 
or  living  in  overheated  quarters.  One  may  contract  a  cold  by 
going  suddenly  from  an  extremely  hot  to  a  very  cold  atmosphere, 
or  vice  versa.  In  all  of  these  conditions  it  is  important  that  the 
patient  should  not  go  out  too  soon  after  the  treatment,  as  the- 
system  is  relaxed  and  more  cold  may  be  contracted. 

*See  "Principles  of  Osteopathy"  Lectures  XVI-XVIII. 


110  PRACTICE    OF    OSTEOPATHY. 

EPISTAXIS. 

DEFINITION:  Epistaxis  is  the  term  used  to  designate 
hemorrhage  from  the  nose.  It  is  found  in  serious  form  in  some 
people.  It  may  be  caused  by  accident,  as  in  fracture  of  the 
skull,  or  by  local  irritation,  such  as  picking  at  the  nose.  It  is 
often  an  incident  in  some  other  disease,  as  in  typhoid  or  influ- 
enza, or  in  anemia,  hemophilia,  plethora,  etc.  In  all  cases  a 
careful  search  should  be  made  for  its  causes  .  For  example,  it 
may  be  due  simply  to  rarefaction  of  air;  or  to  affections  of  the 
nasal  mucosa,  such  as  ulcers,  polypi,  hyperemia,  or  to  contracted 
kidneys  or  valvular  heart  lesions.  Or  it  may  be  brought  on  by 
over  exertion,  by  vigorous  blowing  of  the  nose,  or  by  overeating. 

When  the  cause  is  found  the  case  must  be  treated  accordingly. 
Specific  lesions  present  often  act  as  determining  factors,  and  their 
removal  is  an  important  measure  in  preventing  recurrence  of 
such  hemorrhages.  Cervical  lesion,  involving  the  atlas  and  the 
muscles,  has  been  noted.  Other  forms  of  cervical  lesion,  affect- 
ing the  superior  cervical  ganglion  or  the  cervical  sympathetic 
may  aid  in  causing 'it. 

CASES:  (1)  A  lady  of  53  years  of  age,  suffering  for  three 
years  with  epistaxis,  the  hemorrhage  coming  generally  after 
fatigue.  It  was  often  profuse.  Lesion  existed  as  contractures 
of  the  muscles  of  the  right  side  of  the  neck,  leading  down  to  a 
tender  area  upon  the  point  of  the  right  shoulder.  The  lady  had 
been  injured  here  just  before  the  trouble  came  on  her.  The 
condition  was  cured  in  ten  treatments. 

TREATMENT:  Holding  of  the  facial  artery  where  it  crosses 
the  inferior  maxillary  bone,  and  the  nasal  artery  at  the  inner 
canthus  of  the  eye,  also  pressure  applied  to  the  carotid  arteries 
slow  the  blood-current  and  favor  the  formation  of  a  clot.  In 
some  cases,  friction  over  the  superior  cervical  region  has  been 
enough  to  arouse  sufficient  vaso-constriction  to  stop  the  flow. 
The  case  may  be  helped  by  raising  the  arms  high  above  the 
head.  It  is  frequently  difficult  to  stop  the  hemorrhage  at  the 
time,  but  the  treatment  applied  to  the  correction  of  the  lesion 
and  to  the  freedom  of  circulation  through  the  neck  will  stop  the 
recurrence  of  the  hemorrhages.  In  severe  cases  it  may  be  neces- 


PRACTICE    OF   OSTEOPATHY.  Ill 

sary  to  resort  to  plugging  of  the  posterior  nares.  The  applica- 
tion of  ice  or  cold  water  to  the  superior  cervical  region,  and  the 
use  of  hot  or  cold  injections  into  the  nostrils  are  efficient  domestic 
remedies  for  the  condition.  The  patient  should  rest  quietly, 
and  avoid  blowing  and  wiping  of  the  nose.  Holding  the  nostrils 
shut  may  facilitate  the  formation  of  the  clot.  Injections  of  cold 
water  and  vinegar  into  the  nostrils  are  useful.  A  tampon  of  ab- 
sorbent cotton  in  the  nostril  may  be  sufficient. 

PLEURISY. 

DEFINITION:  An  acute  or  chronic  inflammation  of  a  part  or 
the  whole  of  one  or  both  pleurae,  attended  by  cough  and  pain  in 
the  side,  and  caused  by  lesions  affecting  ribs,  thoracic  vertebrae, 
intercostal  and  spinal  muscles,  nerves,  etc. 

CASES:  (1)  A  case  of  pleurisy  due  to  a  displacement  of 
the  8th  rib. 

(2)  In  a  dentist,  a  case  of  pleurisy  was  developed  by  the 
irritation  by  the  eighth  and  ninth  left  ribs,  which  were  luxated  by 
continued  bending  over  at  his  work.     Correction  of  the  lesion 
cured  the  case. 

(3)  A  case  presented  lesions  in  the  form  of  the  upper  four 
ribs  drawn  together  and  (4)  another  case  showed  merely  vertebral 
lesions. 

CAUSES:  The  important  lesions  in  these  cases  affect  the 
ribs;  cases  are  rare  in  which  lesions  of  this  kind  are  not  present. 
Other  lesions  are  consequent  or  subsidiary  to  rib  lesions.  They 
may  affect  the  ribs  of  either  side,  as  low  as  the  10th  on  the  left 
and  the  9th  on  the  right,  marking  the  lower  limits  of  the  pleurae. 
Secondary  lesions  in  the  cervical  region,  affecting  pneumogastric, 
phrenic,  or  sympathetic  nerves,  concerned  in  the  innervation  of 
the  pleurae,  may  occur.  Lesions  of  the  clavicle  and  first  rib, 
impeding  circulation  through  the  sub-clavian  and  internal  mam- 
mary arteries,  are  important.  The  cervical  lesions  mentioned, 
with  lesions  of  the  spinal  muscles  and  dorsal  vertebrae,  affect  the 
innervation,  composed  of  branches  from  the  pneumogastrics, 
phrenics.  sympathetics,  and  pulmonary  plexuses.  Important 
derangements  of  circulation  are  thus  caused  by  lesion  to  vaso- 
motors,  aiding  the  process  of  inflammation,  which  is  the  active 


112  PRACTICE    OF    OSTEOPATHY. 

morbid  process  in  the  case.  The  drawing  of  spinal  muscles, 
luxations  of  vertebrae,  and  the  interference  with  spinal  nerves 
also  aid  the  causation  of  rib  lesions.  The  latter  sort  is  by  far 
the  most  efficient  in  causing  pleurisy  because  of  its  relation  to 
the  intercostal  vessels  and  nerves.  These  nerves  and  vessels  all 
together  total  a  vast  area  of  blood  and  nerve-supply  to  the  pleu- 
rae, especially  to  the  parietal  portions.  The  nerves  carry  vaso- 
motor  and  secretory  fibres  to  the  parts  supplied  by  them,  hence 
to  the  pleurae.  Hilton  points  out  that  the  nerves  innervating 
the  linings  of  the  body  cavities  supply  also  the  skin  and  muscles 
of  the  walls  of  these  cavities.  This  is  well  instanced  in  the  case 
of  the  parietal  pleurae,  which  are  supplied  by  the  intercostal 
nerves,  they  also  supplying  the  intercostal  and  abdominal  muscles 
and  the  overlying  skin.  Such  being  the  case,  lesion  by  displace- 
ment of  ribs,  irritating  intercostal  nerves,  disturbs  the  vaso-motor 
and  secretory  processes  in  the  pleurae  supplied  by  the  same 
nerves.  Hilton  has  also  pointed  out  that  a  joint,  the  muscles 
moving  the  joint,  and  the  skin  overlying  these  muscles,  are  all 
supplied  by  branches-  of  the  same  nerves.  Hence  vertebral 
lesion  and  lesions  affecting  the  relations  of  the  heads  of  the  ribs 
may  affect  the  nerves  through  their  articular  branches.  In  this 
way  spinal  lesion  might  be  the  origin  of  such  disease.  But  fur- 
ther, since  each  intercostal  nerve  is  connected  by  the  rami  com- 
municantes  with  the  sympathetic  system,  lesion  of  these  nerves 
affects  the  sympathetics.  These  sympathetics  in  the  dorsal 
region  contain  both  vaso-dilator  and  vaso-constrictor  fibres; 
they  enter  into  the  formation  of  the  pulmonary  plexus,  which  in 
part  innervates  the  pleura.  Hence  intercostal  lesion  affects 
vaso-motor  control  of  the  parietal  pleura  directly,  and  of  the 
visceral  pleura  indirectly.  In  another  way  does  intercostal  le- 
sion act  to  set  up  the  inflammatory  process  of  pleurisy.  Lesions 
of  the  clavicle,  deranging  circulation  through  the  sub-clavian  and 
internal  mammary  vessels,  and  of  the  other  ribs,  directly  ob- 
structing the  intercostal  vessels,  and  indirectly  deranging  the 
circulation,  through  related  vessels  to  the  visceral  pleurae,  (bron- 
chial, mediastinal,  and  diaphragmatic  vessels)  disturb  the  en- 
tire circulation  to  these  parts. 

In  these  ways  may  all  the  various  lesions  described  work 


PRACTICE   OF-  OSTEOPATHY.  113 

together  to  produce  inflammation.  The  affected  area  is  larger 
or  smaller  according  to  the  nature  and  extent  of  the  lesions. 
Lesion  of  a  single  rib  has  frequently  been  found  responsible  for 
an  acute  attack  of  pleurisy,  either  circumscribed  and  limited  in 
extent,  or  spreading  to  involve  considerable  areas.  The  same 
sort  of  lesion  may  produce  all  the  various  kinds  of  pleurisy  de- 
scribed in  medical  texts. 

According  to  osteopathic  theory,  the  bacteria  present  in 
this  disease  and  ascribed  by  some  writers  as  its  cause,  could  not 
live  and  propogate  their  poisons  in  healthy  tissues.  The  pres- 
ence of  the  lesions  described  may  weaken  the  tissues  and  allow 
the  microbes  to  gain  a  foothold.  It  is  significant  that  exposure 
to  cold  and  wet,  and  mechanical  injuries  cause  the  disease,  as 
the  osteopath  looks  for  such  causes  to  produce  the  displacements 
and  other  legions  to  which  he  traces  the  disease. 

The  PROGNOSIS  is  good.  Cases  generally  recover  without 
difficulty.  Often  all  the  pain  and  other  manifestations  disap- 
pear at  once  upon  removal  of  lesion;  the  setting  of  a  rib. 

THE  EXAMINATION  AND  TREATMENT:  This  lesion  should  be 
removed  as  soon  as  possible,  and  at  once  if  the  condition  of  the 
patient  will  allow.  Treatment  should  be  directed  to  the  relax- 
ation of  spinal,  intercostal,  and  cervical  tissues,  and  to  the  rais- 
ing of  the  ribs,  for  the  purpose  of  removing  obstruction  from 
from  and  toning  the  circulation  and  innervation  of  the  pleurae. 
The  raising  of  the  ribs  and  clavicle,  including  the  repair  of  the 
particular  luxation  of  ribs  that  is  causing  the  trouble,  are  the 
most  important  steps.  If  the  case  is  seen  before  the  inflamma- 
tion and  exudation  has  progressed  far,  the  process  may  be  more 
easily  stopped,  as  the  necessary  point  is  to  gain  control  of  circu- 
lation, which  may  be  readily  accomplished  through  nerves  and 
vessels  as  already  explained.  In  the  stage  of  exudation,  where 
quantities  of  the  exudate  occur  in  the  pleural  cavities,  attention 
must  be  given  to  releasing  the  tension  in  parts  due  to  contrac- 
tures  of  muscles,  etc.,  to  raising  the  ribs  to  allow  more  free-play 
of  the  lungs;  and  to  the  relief  of  the  pain  in  the  side,  and  the 
distressing  cough,  by  carefully  raising  the  ribs  and  manipulating 
the  tissues  at  the  seat  of  the  pain.  But  the  main  point  at  this 
stage  is.  by  the  treatment  to  the  circulation,  to  hasten  the  re- 


114  PRACTICE    OF    OSTEOPATHY. 

sorption  of  inflammatory  products.  This  may  be  done  to  a  con- 
siderable extent.  Great  care  must  be  taken  in  handling  the  pa- 
tient on  account  of  the  great  pain.  By  stimulating  the  process 
of  absorption,  and  by  keeping  the  parts  free  from  tension  in  the 
tissues,  also  by  keeping  up,  carefully,  free  motion  of  the  ribs  and 
parts,  the  adhesions  of  the  pleura,  and  the  retraction  of  parts 
likely  to  occur  as  a  result  of  the  inflammation,  may  be  avoided. 
This  is  during  the  convalescence  of  the  patient,  when  his  condi- 
tion must  be  carefully  watched.  The  point  may  be  reached  in 
some  cases  where  tapping  might  be  necessary,  but  if  the  case  is 
seen  in  time  the  process  may  be  so  controlled  as  to  obviate  this 
difficulty.  In  cases  of  adhesions  between  the  pleurae,  if  painful 
they  should  be  gradually  broken  up.  This  is  done  in  a  course  of 
treatment,  carefully  giving  the  parts  concerned  the  extremes  of 
motion  of  which  they  are  capable.  The  process  it  aided  by  develop- 
ing the  circulation  to  in  part  absorb  the  adhesive  tissues.  This 
must  frequently  be  done  in  the  chronic  case.  The  treatment  of 
such  cases  consists  mainly  in  correction  of  lesion,  and  in  main- 
taining free  circulation  for  the  absorption  of  pus,  if  present. 

In  treatment  of -pleurisy,  stimulation  of  heart  and  lung:-;. 
of  bowels,  kidneys  and  superficial  fascia,  for  the  removal  of 
poisonous  waste;  and  attention  to  the  general  health  of  the  pa- 
tient, are  necessary.  Acute  cases  should  be  kept  upon  a  light, 
easily  digested  diet.  Exposure  must  be  prevented.  One  thor- 
ough treatment  daily,  with  more  treatment  at  times  during  the  day 
for  the  relief  of  pain,  etc.,  will  usually  be  sufficient.  Chronic 
cases  should  be  treated  three  times  per  week. 

PNEUMOTHORAX  (Hydropneumothorax.    Pyopneumothorax). 
HYDROTHORAX  (Dropsy  of  the  Pleura)  and  HEMOTHORAX. 

In  all  of  these  conditions  the  situation  which  confronts 
the  Osteopath  is  much  the  same.  Xo  particular  LESION  can 
be  mentioned  for  the  causation  of  these  diseases  directly.  They 
are  all  usually  secondary  to  other  diseased  conditions,  and  the 
lesion  of  the  primary  disease  is  the  one  responsible  for  the  trouble. 
Pneumothorax  and  hemothorax  may  occur  from  violence,  no 
ordinary  lesion,  of  course,  having  anything  to  do  with  such  a 
result.  The  lesion  is  otherwise  the  one  producing  the  disease 


PRACTICE  OF  OSTEOPATHY.  115 

of  heart,  lungs,  kidneys,  or  of  the  general  system,  to  which  these 
conditions  are  secondary,  and  must  be  sought  and  treated  ac- 
cordingly. Naturally  such  lesions  may  have  much  to  do  with 
weakening  the  lung  tissues,  vessels,  and  other  structures,  pre- 
liminarily to  one  of  these  diseases. 

The  PROGNOSIS  in  these  conditions  is,  generally  speaking, 
fair.  Much  may  be  done  for  the  relief  of  the  patient.  The 
prognosis  for  cure  depends  upon  that  for  the  original  disease. 

In  the  TREATMENT  the  practitioner  has  in  view  three  main 
objects:  (1)  to  relieve  the  painful  or  troublesome  symptoms, 

(2)  To  treat  the  original  disease,  or  remove  the  active  cause, 

(3)  To  absorb  the  gas  or  fluid  from  the  pleura!  cavity. 

In  cases  of  pneumothorax  the  treatment  is  in  most  respects 
like  that  for  pleurisy.  Spinal  inhibition,  relaxation  of  spinal 
and  intercostal  tissues,  and  careful  elevation  of  the  ribs  quiets 
the  pain,  gives  more  freedom  to  the  lungs,  and  reileves  the  dysp- 
nea. A  general  spinal  treatment  should  be  given  to  equalize 
the  systemic  circulation.  For  the  absorption  of  the  gas  and 
fluid  one  should  proceed  as  in  pleurisy,  q.  v.  If  much  pus  be 
present  it  should  be  drained. 

In  hydrothorax  the  treatment  would  be  practically  the 
same.  As  these  cases  are  usually  due  to  chronic  heart,  lung, 
or  kidney  diseases,  particular  attention  must  be  given  to  the 
treatment  of  the  diseased  part.  Any  obstruction  to  free  cir- 
culation must  be  removed.  In  anemic  and  cachetic  states  at- 
tention must  be  given  to  the  general  system  to  build  up  the  health. 
As  there  is  no  inflammatory  process,  the  absorption  of  the  transu- 
date  is  accomplished  as  is  that  of  the  pleuritic  effusion  after  the 
inflammation  has  been  controlled.  The  heart  and  lungs  must 
be  kept  well  stimulated  to  increase  the  vigor  of  the  heart,  render 
the  general  circulation  active,  and  thus  decrease  the  pressure  in 
the  venous  system.  If  the  accumulation  of  fluid  threatens  suf- 
focation, paracentesis  must  be  performed. 

In  hemothorax  the  primal  y  step  is  to  insure  absolute  rest 
of  the  patient  and  to  control  the  hemorrhage.  This  may  be 
done  much  as  in  pulmonary  hemorrhage,  q.  v.  All  stimula- 
tion must  be  avoided.  After  the  clot  is  formed  absorption 
will  proceed  naturally.  Later  one  may  give  such  treatment 


116  PRACTICE    OF    OSTEOPATHY. 

as  will  insure  complete  absorption,  and  restore  entire  freedom 
to  the  activity  of  the  lungs.     (See  Pleurisy.) 

LARYNGITIS. 

'  DEFINITION:  An  acute  inflammation  of  the  mucous  mem- 
brane lining  the  larynx.  In  acute  and  chronic  catarrhal  forms 
the  inflammation  is  a  catarrhal  condition.  In  the  spasmodic 
form  (laryngismus  stridulus),  the  condition  is  a  nervous  one. 
(See  Croup.)  In  the  edematous  /form  the  inflammation  is  ac- 
companied by  exudation  and  infiltration  of  the  tissues.  This 
form  is  also  known  as  Edema  of  the  Larynx. 

CASES:  (1)  A  case  of  chronic  laryngitis  due  to  lesions 
as  follows:  left  cervical  muscles  sore;  1st  cervical  vertebra  up; 
2nd,  down;  5th  cervical  vertebra  posterior.  The  right  eye  was 
weak  and  the  tear-duct  was  closed.  Aphonia  would  occur  fre- 
quently for  several  weeks. 

(2)  An  acute  attack  of  laryngitis  in  a  singer  wras  overcome 
by  a  single  treatment  upon  several  occasions,  enabling  him  to 
sing  in  public. 

(3)  A  case  in  which  a  few  minutes  treatment  of  the  hyoids, 
etc.,  enabled  a  singer  to  readily  run  the  scale  to  a  high  note, 
previously  beyond  her  reach. 

(4)  A  case  in  which  chronic  laryngeal  disease  had  destroyed 
a  finely  cultivated  voice,  in  which,  after  the  failure  of  treatment 
by  specialists,  an  Osteopath  found  weakness  of  the  epiglottis. 
Treatment  strengthened  it,  restored  it  to  free  action,  and  re- 
covered the  voice. 

(5)  A  case  of  aphonia  frequently  fully  relieved  by  a  few 
minutes  treatment. 

(6)  A  case  of  aphonia,  due  to  spinal  injury,  cured  in  two 
months. 

CAUSES:  Lesions  to  the  innervation  and  blood-supply  of 
the  larynx  are  present.  The  chief  ones  are  to  the  pneumogas- 
trics  and  cervical  sympathetics,  and  occur  at  the  atlas,  axis  and 
third  cervical  vertebra,  where  they  affect  the  superior  cervical 
ganglion,  and  through  it  the  nerves  in  question.  Cervical  lesion 
may  also  affect  the  other  cervical  sympathetics  concerned  in  the 
innervation  of  the  larvnx.  These  lesions  affect  circulation  of  the 


PRACTICE  OF  OSTEOPATHY.  117 

larynx  through,  the  innervation.  Direct  lesion  to  the  blood- 
vessels may  occur  at  the  clavicle  and  first  rib,  at  the  deep  anterior 
cervical  tissues,  and  in  the  muscles  along  the  neck  anteriorly, 
and  about  the  throat.  They  may  obstruct  the  circulation  in  the 
carotid  arteries  and  the  thyroid  axis,  or  may  impede  the  venous 
return  through  the  small  veins  and  the  innominates  and  internal 
jugulars.  Local  weakness  of  the  glottis,  or  of  the  laryngeal  mus- 
cles, may  occur  primarily  or  secondarily  to  other  lesion.  The 
edematous  form  is  especially  likely  to  be  caused  by  obstruction 
to  the  internal  jugular  veins.  Traumatism  may  be  the  sole  cause, 
or  cold, -exposure,  and  irritation,  etc.,  may  act  secondarily  to  cer- 
vical lesion  to  cause  the  disease. 

The  PROGNOSIS  is  good.  Immediate  relief  is  obtained  from 
the  treatment,  and  recovery  soon  follows. 

In  dangerous  cases  of  edematous  laryngitis  great  care  must 
be  taken.  Tracheotomy  may  become  necessary  in  some  cases, 
but  ordinarily  this  can  be  avoided  by  the  treatment  if  the  case 
be  seen  in  time. 

The  TREATMENT  must  be  directed  as  far  as  possible  to  the 
immediate  removal  of  the  specific  lesion.  This  releases  circula- 
tion and  nerve-supply  as  shown  above.  The  tissues  of  the  neck, 
particularly  of  the  throat,  must  be  thoroughly  relaxed ;  the  clavicle 
is  raised,  and  the  deep  anterior  muscles  and  tissues  of  the  root  of 
the  neck  are  treated.  These  treatments  free  the  circulation  in 
the  vessels  as  shown  above.  The  circulation  in  the  carotids  is 
further  aided  by  opening  the  mouth  against  resistance.  The 
vagus  is  treated  along  the  course  of  the  sterno-mastoid  muscle, 
and  at  the  superior  cervical  region.  Its  superior  laryngeal 
branch  is  treated  behind  the  superior  cornua  of  the  thyroid  cartil- 
age. Its  recurrent  laryngeal  branch  is  reached  at  the, inner  side 
of  the  lower  portion  of  the  sterno-mastoid  muscle  at  about  the 
level  of  the  cricoid  cartilage. 

Deep  treatment  is  made  along  the  course  of  the  larynx  and 
trachea,  from  the  hyoid  bone  and  muscles  to  the  root  of  the  neck. 
Care  must  be  taken  to  apply  the  fingers  of  the  operating  hand 
close  along  the  sides  of  the  trachea.  This  is  excellent  treatment 
for  the  huskiness  and  the  spasm.  The  latter,  however,  is  apt  to 
depend  upon  some  special  lesion.  In  spasmodic  laryngitis  the 


118  PRACTICE    OF    OSTEOPATHY. 

epiglottis  is  sometimes  caught  in  the  rima,  and  must  be  released 
by  introducing  the  index  finger  into  the  throat.  Treatment  of 
the  phrenics  and  the  diaplaragm  aid  in  lessening  the  spasm  by 
quieting  the  action  of  the  diaphragm.  A  warm  bath  is  recom- 
mended to  break  up  the  spasm.  In  a  child  with  an  overloaded 
stomach,  to  cause  vomiting  affords  relief. 

The  vagi  and  cervical  sympatheics  are  treated  at  the  superior 
cervical  region  and  along  the  posterior  region. 

In  acute  cases  inhalations  of  steam  are  helpful.  If  there  be 
much  swelling  and  pain,  the  patient  may  be  relieved  by  sucking 
ice.  In  case  of  stenosis,  apply  a  mustard  plaster  or  cold  compress 
to  the  front  of  the  neck. 

Chronic  cases  must  avoid  exposure,  and  irritation  of  the 
throat,  as  from  overuse,  also  smoking  and  alcohol. 

Cases  of  aphonia,  due  to  the  changes  in  the  vocal  cords,  or 
to  weakness  of  the  epiglottis,  may  be  cured  by  this  treatment. 

In  edema  of  the  larynx  due  to  a  dropsy  from  kidney,  heart, 
or  lung  disease,  attention  must  be  given  to  the  general  dropsical 
condition  and  its  cause.  In  dangerous  cases  of  edema  an  opera- 
tion becomes  necessary  to  prevent  suffocation.  Short  of  this, 
hot  foot-baths,  hot  drinks,  milk,  or  seltzer-water  give  relief. 

DISEASES  OF  THE  DIGESTIVE  TRACT. 

STOMATITIS  AND  GLOSSITIS. 

DEFINITION:  Stomatitis  is  an  inflammation  of  the  mucous 
membrane  lining  of  the  mouth.  It  may  be  catarrhal  (simple 
or  acute  stomatitis) ;  ulcerative  (putrid  sore  mouth) ;  aphthous 
(aphthae,  vesicular  stomatitis);  parasitic  (thrush,  muguet); 
mercurial  (ptyalism) ;  or  gangrenous  (noma,  cancrum  oris). 

To  the  Osteopath  these  various  forms  present,  in  each  case, 
practically  the  same  aspects,  so  far  as  lesion  and  method  of  pro- 
cedure are  concerned. 

Glossitis  is  an  acute  or  chronic  parenchymatous  inflammation 
of  the  tongue. 

Stomatitis  and  glossitis  may  be  discussed  together.  The 
latter  condition  commonly  complicates  the  former;  both  are 
forms  of  a  vaso-motor  disturbance  referable  to  practically  the 


PRACTICE  OF  OSTEOPATHY.  119 

same  nerve  and  blood-mechanism;  both  present  the  same  bony 
lesions  and  are  treated  in  the  same  manner. 

CASES:  (1)  Glossitis;  the  tongue  raw  and  fissured  for 
weeks;  irritation  was  extending  to  the  stomach.  Lesion  was 
present  as  a  contracture  of  the  supra-hyoid  muscles,  drawing 
the  hyoid  bone  back  against  the  pneumogastric  nerve,  and  ob- 
structing the  blood-drainage  via  the  throat.  After  the  tissues 
were  relaxed  and  the  bone  restored  to  its  normal  position  the 
patient  recovered. 

(2)  Glossitis,  in  a  patient  with  a  diseased  gastro-intestinal 
tract,  due  to  poisoning  of  the  system  by  a  patent  medicine. 
Quickly  relieved  by  treatment  to  throat,  neck,  and  emunctories. 

(3)  Case   of   glossitis,    and   stomatitis    (ulcerative) ,   due   to 
bony  neck  lesions. 

(4)  Stomatitis  associated  with  pharyngitis;  medicines  were 
used  to  no  purpose.     The  patient  was  unable  to  eat  for  16  days. 
After  two  days  osteopathic  treatment  he  could  eat,  and  the  con- 
dition was  cured  in  one  week. 

LESIONS  AND  ANATOMICAL  RELATIONS. 

In  these  cases  there  is  generally  lesion  to  the  bony  or  other 
tissues  in  the  cervical  region  (sometimes  also  in  the  upper  dor- 
sal,) which  deranges  vaso-motor  control  of  the  tissues  of  the 
mouth  and  tongue,  obstructs  venous  return,  weakens  the  tissues, 
and  lays  them  liable  to  the  effects  of  some  particular  irritant, 
local  or  in  the  system,  but  there  is,  generally,  lesion  affecting  the 
gastro-intestinal  tract  which  is  the  real  underlying  cause  of  the 
trouble.  Naturally  there  are  many  cases  due  to  the  irritation  of 
a  poisonous  drug,  of  a  decayed  tooth,  etc.,  which  suffer  from  no 
specific  lesion.  Yet  the  ordinary  case  shows  cervical  or  upper 
dorsal  lesion  of  some  kind.  Lesions  to  the  atlas,  axis,  lower  cer- 
vical, or  upper  dorsal  vertebrae;  sometimes  of  the  upper  few  ribs; 
of  the  clavicle;  of  the  cervical  muscles,  especially  those  of  the 
throat ;  of  the  hyoid  bone;  of  the  lower  jaw,  may  be  present. 

These  lesions  derange  the  nerve  and  blood-supply  of  the 
mouth  and  tongue.  Contractured  throat  muscles  may  shut 
down  upon  the  arterial  and  venous  circulation  (carotid,  jug- 
ular), mechanically  deranging  it.  Lesion  of  the  clavicle,  first 


120  PRACTICE    OF    OSTEOPATHY. 

rib,  and  deep  anterior  cervical  tissues  may  cause  the  same  re- 
sults. Contractured  muscles  in  the  cervical  region,  displaced 
vertebrae  and  ribs,  may  all  disturb  the  spinal  and  sympathetic 
nerve-connections  having  control  of  these  tissues.  Inferior 
maxillary  lesion  may  disturb  the  5th  nerve  by  impinging  its 
articular  branches. 

The  vaso-motor  supply  of  tongue  and  lining  membranes 
of  the  mouth  are  mainly  from  the  fifth  cranial  nerve.  Accord- 
ing to  the  American  Text-book  of  Physiology,  the  vaso-dilator 
fibers  for  the  face  and  mouth  are  found  in  the  cervical  sympa- 
thetics;  they  emerge  from  the  spinal  cord  by  way  of  the  2nd 
to  5th  spinal  nerves,  and  connect  with  the  fifth  cranial  nerve 
by  passing  from  the  superior  cervical  ganglion  to  the  Gaserian 
ganglion.  Other  dilator  fibers  for  the  mucous  membrane  of  the 
mouth  seem  to  arise  in  the  fifth  nerve  itself. 

The  same  authority  shows  that  the  cervical  sympathetic 
contains  vaso-constrictor  fibers  for  the  tongue.  The  hypo- 
glossal  nerve  also  contains  vaso-constrictor  fibers  for  the  tongue. 
The  lingual  (a  branch  of  the  fifth)  and  the  glosso-pharyngeal 
nerves  contain  vase-dilators  for  the  tongue. 

In  view  of  these  facts  it  becomes  at  once  apparent  that  atlas 
and  axis,  lower  cervical  and  upper  dorsal  vertebral  lesion,  as  well 
as  upper  rib  lesion  could  affect  these  sympathetic  connections  of 
the  fifth  nerve,  along  this  portion  of  the  spine,  and  lead  to  a  de- 
rangement of  the  vaso-motor  state  of  the  tissues  of  tongue  and 
mouth.  (See  also  the  anatomical  discussion  under  Catarrh.) 
Upper  cervical  lesion  could  likewise  affect  the  glosso-pharyngeal 
and  hypoglossal  nerves,  since  both  are  connected  with  the  super- 
ior cervical  ganglion.  The  glosso-pharyngeal  is  also  connected 
with  the  fifth,  and  could  suffer  with  it  from  lesion.  The  hypo- 
glossal  is  connected  with  both  the  fifth  and  the  facial  nerves. 

In  these  diseases,  secondary  lesions  resulting  in  constitu- 
tional conditions  favoring  them  will  be  found. 

The  PROGNOSIS  in  stomatitis  and  glossitis  is  good.  The 
case  usually  quickly  recovers  under  the  treatment.  One  or  a 
few  treatments  give  relief,  and  a  short  course  of  treatment  is 
usually  all  that  the  case  requires.  In  gangrenous  stomatitis. 


PRACTICE    OF    OSTEOPATHY.  121 

however,  the  prognosis  must  be  guarded.  It  is  usually  a  surgical 
•case. 

The  TREATMENT  must  be  directed  particularly  to  the  re- 
moval of  the  lesion.  Frequently  the  removal  of  this  irritation 
results  at  once  in  a  rapid  recovery.  Thorough  cervical  treat- 
ment must  be  carefully  given.  Following  corrective  work  upon 
the  lesion,  all  the  cervical  tissues  must  be  entirely  relaxed.  Es- 
pecially all  the  tissues  about  the  throat  and  angles  of  the  jaws 
should  be  relaxed,  but  the  treatment  in  these  places  must  be  gentle 
to  avoid  irritation.  The  deep  anterior  cervical  tissues  low  down 
should  be  thoroughly  relaxed,  and  the  clavicles  should  be  raised 
to  aid  in  free  venous  drainage  from  the  affected  parts.  The  lower 
jaw  should  be  carefully  opened  against  resistance.  One  should 
.see  that  the  adjustment  of  the  temporo-maxillary  articulations 
is  correct. 

In  all  forms  of  stomatitis,  proper  attention  must  be  given 
to  cleanliness  of  the  mouth,  It  should  be  kept  well  washed  out. 
A  mild  alkaline  wash  is  recommended.  Proper  attention  must  be 
given  to  the  general  health.  Bowels  and  stomach  should  be  kept 
active  and  in  good  condition.  In  aphthous  stomatitis,  especial 
care  must  be  taken  to  correct  disturbed  digestion,  and  the  mouth 
should  be  washed  before  food  is  given.  In  parasitic  stomatitis 
the  child's  tongue  should  be  wiped  off  with  a  soft  cloth/  It  is 
recommended  to  soak  the  cloth  in  boric  acid  solution. 

Gangrenous  stomatitis  usually  becomes  a  surgical  case  unless 
successfully  handled  early. 

In  catarrhal  stomatitis  and  in  acute  glossitis  ice  may  be 
applied  to  the  tongue  and  to  the  angles  of  the  jaws.  Antiseptic 
mouth  washes  are  good  in  glossitis.  In  chronic  glossitis  the  food 
should  be  plain.  All  stimulating  or  irritating  articles,  such  as 
-alcohol  and  tobacco  should  be  avoided.  The  teeth  should  be 
kept  in  good  repair,  and  bowels  and  stomach  must  be  kept  active. 

In  mercurial  stomatitis  stop  all  mercury  and  use  a  mouth- 
wash  of  listerine. 

DISEASES  OF  THE  SALIVARY  GLANDS. 

HYPERSECRETION,  XEROSTOMA. 
In  Hypersecretion  (Ptyalism)  and  Xerostoma  (Dry  Mouth) 


122  PRACTICE    OF    OSTEOPATHY. 

one  must  expect  much  the  same  style  of  lesion  as  in  glossitis  and 
stomatitis,  as  the  fifth  nerve  and  the  cervical  sympathetics  are 
again  the  ones  chiefly  involved  in  the  disease. 

Quain's  anatomy  states  that  secretory  fibres  for  the  sub- 
maxillary  glands  arise  mainly  from  the  second  and  third  dor- 
sal spinal  nerves.  They  ascend  through  the  cervical  sympa- 
thetic. The  fifth  nerve,  according  to  Dana,  is  the  nerve  pre- 
siding over  salivation.  The  American  Text-Book  of  Physi- 
ology points  out  .that  vaso-constrictor  fibres  for  the  salivary 
glands  are  contained  in  the  cervical  sympathetics.  The  chorda- 
tympani  branch  of  the  facial  nerve  is  the  vaso-dilator  of  the  sub- 
maxillary  gland.  The  glosso-pharyngeal  nerve  furnishes  secre- 
tory and  vaso-dilator  fibres  to  the  parotid  gland.  The  glosso- 
pharyngeal  and  facial  nerves  are  closely  connected  with  the  fifth, 
and  may  suffer  with  it  from  lesion. 

From  the  foregoing  facts  it  is  easily  seen  that  lesions  in  the 
upper  dorsal  and  cervical  regions,"  etc.,  as  pointed  out  for  stom- 
atitis, may,  any  of  them,  under  the  proper  conditions,  derange 
the  vaso-motor  and  secretory  conditions  of  these  glands  and  lead 
to  hypersecretion  or  dryness. 

Hypersecretion  is  sometimes  of  reflex  origin  from  diseases 
of  the  teeth  and  mouth,  digestive  organs,  sexual  organs,  etc. 
In  such  cases  it  is  still  probable  that  the  lesion  has  an  affect  in 
determining  the  disease  to  these  glands.  No  lesion  may  be  pres- 
ent when  ptyalism  is  due  to  the  use  of  a  drug,  such  as  mercury, 
gold,  copper,  etc.  Xerostoma  is  thought  to  be  due  to  an  affec- 
tion of  the  nerve-supply  of  all  the  glands  of  the  mouth. 

PROGNOSIS:  Ordinarily  good  success  is  had  in  correcting 
these  conditions.  The  prognosis  must  depend  upon  that  for  the 
disease  to  which  these  are  commonly  secondary. 

The  TREATMENT  must  be  directed  to  the  removal  of  the 
lesion,  as  well  as  of  the  disease  upon  which  the  condition  may 
depend.  A  thorough  neck  and  upper  dorsal  treatment  should 
be  carried  out  upon  the  lines  laid  down  for  the  treatment  of 
stomatitis.  Removal  of  lesion  and  treatment  of  nerve  and 
blood-supply  does  much  to  correct  the  secretions. 

Local  work  over  the  region  of  the  glands  externally,  relax- 
ing the  tissues  and  stimulating  the  gland  directly  is  much  used 


PRACTICE    OF    OSTEOPATHY.  123 

in  dryriess  of  the  mouth  in  fevers.     It  is  quite  successful. 

Care  for  the  general  health  is  an  important  measure  in  the 
treatment  of  these  conditions.  It  is  fully  as  important  as  is  the 
specific  treatment.  The  secretions  of  the  body  cannot  be  re- 
stored to  normal  unless  the  general  health  be  repaired,  inasmuch 
as  most  of  these  conditions  depend,  fundamentally,  upon  sys- 
temic conditions.  The  frequent  use  of  small  amounts  of  water, 
or  of  a  little  oil  in  the  mouth,  is  a  measure  of  relief. 

INFLAMMATIONS  OF  THE  SALIVARY  GLANDS. 

For  Specific  Parotitis  see  "Parotitis."  Parotid  Bubo  and 
Chronic  Parotitis  would  be  regarded,  osteopathically,  from 
much  the  same  standpoint  as  parotitis,  as  far  as  specific  lesion 
and  mode  of  treatment  are  concerned. 

As  parotid  bubo  is  not  a  primary  affection,  particular  at- 
tention must  be  given  to  the  condition  which  it  complicates. 
As  most  of  the  cases  are  septic  a  special  effort  must  be  made  to 
free  the  system  of  poison  by  active  work  upon  bowels,  kidneys 
and  skin.  Thorough  treatment  must  be  given  to  the  gland  to 
guard  against  suppuration. 

TONSILLITIS. 

DEFINITION:  Tonsillitis  is  an  inflammation  of  the  tonsils, 
accompanied  by  enlargement  of  the  gland,  fever  and  various 
constitutional  symptoms.  It  is  caused  by  lesions  in  the  cervical 
region. 

CASES:  (1)  A  case  showing  a  right  curvature  of  the  spine; 
2nd  and  4th  cervical  vertebrae  were  sore;  the  cervical  muscles 
upon  each  side  were  contractured ;  the  3rd  to  6th  dorsal  vertebrae 
posterior.  Vertigo  was  also  present. 

(2)  A  case  showing  a  straight  spine,  with  many  vertebral 
luxations,  and  emaciation  of  the  upper  dorsal  muscles. 

(3)  An  acute  case  cured  by  two  treatments  thirty  minutes 
apart. 

(4)  A  case  in  which  the  tonsils  were  ulcerated.     After  four 
treatments  the  swelling  and  inflammation  were  reduced,  and  the 
ulcers  healed  in  a  few  days. 

(5)  A  case  sick  for  five  days,  the  usual  medical  treatment 


124  PRACTICE    OF   OSTEOPATHY. 

affording  no  relief.  The  fever  was  high.  After  one  treatment 
the  size  of  the  tonsils  was  reduced  and  the  patient  slept  for  the 
first  time  in  two  days.  Upon  .the  third  day  of  treatment  the 
patient  was  out. 

(6)  A  case  in  a  boy  three  years  old,  in  which,  after  unsuc- 
cessful medical  treatment  for  two  months,  removal  of  the  tonsils 
was  advised.     They  were  so  enlarged  as   to  almost   close  the 
throat.     They  were  soon  restored  to  normal  size  by  treatment 
directed  to  the  upper  cervical  region,  and  to  the  glands,  exter- 
nally and  internally. 

(7)  A  case  of  acute  tonsillitis  in  a  boy  of  four  years,  whose 
tonsils  were  chronically  enlarged.     The  attacks  were  frequent 
and  severe,  lasting  four  or  five  days,  and  confining  the  child  to  his 
bed.     During  an  attack,  one  treatment  reduced  the  fever,  and 
four  more  treatments  overcame  all  inflammation.     The  lesions 
were;  contracture  of  upper  cervical  ligaments  and  muscles,  and 
slight  luxation  of  the  atlas  to  the  right.     The  lesions  were  cor- 
rected in  less  than  two  months,  the  chronic  enlargement  was 
overcome,  and  in  the  nine  subsequent  months  but  one  slight  acute 
attack  occurred.    ' 

CAUSES:  The  lesion  in  the  case  may  affect  the  general 
cervical  region,  but  usually  occurs  high  up,  affecting  the  atlas, 
axis,  or  third  vertebra.  The  lower  vertebrae  are  often  found  lux- 
ated, and  contracture  of  the  posterior  and  lateral  cervical  tissues 
often  acts  as  the  primary  lesion.  Contracture  of  the  upper  hyoid 
muscles  is  always  present,  frequently  as  secondary  lesion.  Lux- 
ation of  the  clavicle  and  first  rib.  and  tension  in  the  deep  anterior 
cervical  tissues  about  them  are  sometimes  found.  Systemic 
conditions  are  often  very  prone  to  induce  attacks.  Often  these 
begin  as  biliousness  and  constipation,  or  as  a  nervous  upset,  or 
as  a  feature  of  a  cold.  It  is  probable  that  many  of  the  more 
particular  lesions  found  are  secondary.  Attention  must  be  given 
to  the  system,  and  the  general  causes  must  be  sought  in  its  con- 
dition. 

Lesions  of  the  atlas,  axis,  and  third  vertebra  probably  act 
by  affecting  the  fifth  nerve  through  its  connections  with  the 
superior  cervical  ganglion.  Lesions  of  the  throat,  of  the  deep 
anterior  cervical  tissues,  and  of  the  first  rib  and  clavicle,  have 


PRACTICE    OF    OSTEOPATHY.  125 

an  important  effect  by  obstructing  the  circulation  through  the 
carotid  arteries  and  the  internal  jugular  vein. 

In  persons  subject  to  tonsillitis  through  the  presence  of 
these  specific  lesions,  acute  attacks  are  frequently  aroused  by 
exposure  to  cold  and  wet,  by  bad  hygienic  surroundings,  and 
by  various  nervous  disturbances. 

The  PROGNOSIS  is  good  in  the  acute  follicular  and  acute 
suppurative  forms  and  in  ordinary  chronic  enlargement  of  the 
glands.  One  or  a  few  treatments  may  cure  the  case  in  the  acute 
forms.  Great  relief  is  almost  invariably  given  immediately  by 
the  treatment.  The  chronic  enlargement  requires  long  contin- 
ued treatment.  In  the  chronic  form  described  as  naso-pharyn- 
geal  obstruction,  or  mouth  breathing,  the  prognosis  for  cure  is 
not  good.  Much  relief  can  be  given,  and  long  continued  treat- 
ment aids  the  retarded  mental  and  bodily  development. 

Although  Salinger  and  Kalteyer's  ''Modern  Medicine"  states 
that  acute  follicular  tonsillitis  cannot  be  aborted,  it  is  the  com- 
mon experience  with  Osteopathy  to  abort  the  disease. 

In  the  TREATMENT  of  acute  tonsillitis,  due  attention  must 
be  given  general  constitutional  condition.  Liver,  bowels,  kid- 
neys and  skin  must  be  kept  active.  Thorough  spinal  treatment 
should  be  given  for  tonic  effect.  The  treatment  should  be  di- 
rected at  once  to  the  reduction  of  the  spinal  lesion.  Treatment 
is  given  the  upper  three  cervical  vertebne  to  affect  the  superior 
cervical  ganglion.  All  the  muscles  and  tissues  of  the  neck  are 
gently  but  thoroughly  relaxed.  Careful  treatment  is  made  over 
the  suprahyoid  muscless  and  over  the  region  of  the  tonsils.  The 
extreme  tenderness  will  allow  of  but  gentle  treatment,  but  by 
exercising  care  in  applying  the  treatment  at  first,  a  deep  and 
thorough  treatment  may  be  given  after  preliminary  relaxation 
of  the  tissues.  All  the  cervical  vertebrae  and  posterior  tissues 
should  be  thoroughly  treated  for  the  sympathetic  connections  of 
the  fifth.  (Chap.  IV.)  The  treatment  over  the  throat  as  de- 
scribed is  to  relieve  the  inflammation  by  freeing  the  circulation 
in  the  substance  of  the  gland  and  in  the  carotid  and  internal  jugu- 
lar veins.  As  the  large  arterial  supply  is  from  branches  of  the 
external  carotids,  particular  treatment  is  made  along  them  by 
relaxing  the  muscles  and  tissues  over  them  and  by  opening  the 


126  PRACTICE    OF    OSTEOPATHY. 

mouth  against  resistance  as  already  described.  This  work  over 
the  throat  is  carried  well  down  to  the  root  of  the  neck  over  the 
carotid  arteries  and  internal  jugular  veins. 

Manipulation  over  the  tonsil  aids  the  flow  of  the  blood  through 
the  tonsillar  plexus  of  veins  into  the  internal  jugular.  This 
vein  is  freed  by  raising  the  clavicle  and  relaxing  the  anterior 
cervical  tissues  about  it  and  the  first  rib.  Momentary  pressure 
should  be  made  upon  these  veins,  one  at  a  time,  followed  by 
downward  stroking  from  over  the  gland  and  down  the  vein.  If 
this  be  repeated,  and  kept  up  for  a  few  minutes,  the  acute  en- 
largement can  be  quite  reduced  for  the  time.  In  the  same  way 
the  carotid  artery  is  stimulated  in  action.  Circulation  in  the 
substance  of  the  gland  is  aided  by  internal  treatment  in  the 
throat,  made  by  sweeping  and  pressing  the  index  finger  over  the 
gland,  fauces  and  surrounding  tissues.  This  gives  much  relief. 
All  the  treatment  directed  to  the  throat  and  inferior  cervical 
region  is  the  most  important  part  of  the  treatment.  The  large 
blood-supply  of  the  gland,  and  our  ability  to  reach  it  directly 
more  than  through  the  innervation,  make  this  part  of  the  treat- 
ment important.  'It  is  readily  efficient.  Treatment  to  the  first 
rib  and  over  the  upper  anterior  chest  aids  circulation.  The  cold 
pack  to  the  throat,  or  hot  applications  give  relief.  The  diet 
should  be  liquid,  bland  and  nourishing,  such  as  milk  and  broth. 

The  tonsils  should  be  kept  free  from  accumulation  of  secre- 
tions, which  persist  in  chronic  cases.  The  fever  is  treated  in  the 
same  way,  being  affected  by  the  superior  cervical  and  spinal 
work.  The  spinal  and  general  treatment  relieves  the  chilly 
feelings,  aches,  etc.  The  neck  and  throat  treatments  relieve 
the  sore  throat.  Careful  treatment  will  prevent  suppuration 
in  the  suppurative  form  (Quinsy).  The  general  tonic  treat- 
ment must  be  persistent  in  these  cases  because  of  the  severe 
general  symptoms. 

Acute  cases  should  be  treated  daily  one  or  more  times  as 
necessary.  A  few  treatments  are  generally  sufficient.  The 
chronic  enlargements  (hypertrophy)  and  the  chronic  naso-pharyn- 
geal  obstruction  should  be  treated  three  times  per  week.  In  the 
latter,  local  treatment  upon  the  gland  from  within  the  throat  is 
very  helpful.  Many  of  these  cases  are,  in  fact,  tubercular,  and 


PRACTICE    OF   OSTEOPATHY.  127 

the  practitioner  must  be  observant  of  such  condition.  Long 
continued  treatment  should  be  urged  in  all  chronic  cases  to  pre- 
vent, or  to  overcome,  retarded  mental  and  physical  development. 

PAROTITIS. 

DEFINITION:  Parotitis  or  mumps  is  an  acute  inflammation 
of  the  parotid  glands. 

CAUSES:  The  lesions  in  such  cases  affect  the  upper  cer- 
vical region,  mainly  the  atlas,  axis  and  third  vertebra.  Other 
cervical  vertebrae  may  be  luxated,  and  the  cervical  muscles  are 
contractured.  The  deep  anterior  cervical  tissues  may  be  tensed, 
and  clavicle  luxated.  Secondary  contracture  occurs  in  the 
muscles  and  tissues  over  the  region  of  the  gland. 

Lesions  of  the  upper  three  cervical  vertebrae  -and  to  the 
tissues  affect  the  superior  cervical  ganglion,  and  thus  the  carotid 
plexus  through  its  ascending  branch;  the  fifth  nerve  through 
this  ganglion  and  through  its  sympathetic  connections,  and  thus 
its  auriculo-temporal  branch;  the  second  cervical  nerve,  and  thus 
its  auricular  branch;  while  lesions  to  the  muscles  in  this  region 
may  affect  the  facial  nerve  directly,  and  these  other  lesions  affect 
it  through  the  sympathetic  connections.  Contraction  of  the 
tissues  over  the  course  of  the  external  carotid  arteries  and  the 
external  jugular  veins  affect  the  flow  of  the  blood  to  and  from 
the  gland.  Luxation  of  the  clavicle  and  its  tissues  affects  the 
external  jugular  vein. 

The  PROGNOSIS  is  good.  Treatment  is  rapidly  effective, 
and  the  course  of  the  disease  is  shortened  from  the  usual  course, 
seven  to  ten  days,  to  three  or  four  days.  Some  cases  may  become 
obstinate  and  require  longer  treatment. 

The  TREATMENT  is  in  most  particulars  identical  with  that 
given  for  tonsillitis,  q.  v.,  the  lesions  to  vertebrae,  tissues,"  and 
clavicle,  etc.,  being  practically  the  same. 

The  tissues  over  and  about  the  gland  may  be  more  read- 
ily relaxed  as  the  condition  is  less  painful.  The  swelling  is 
more  persistent,  and  requires  more  treatment.  The  fever  is 
treated  as  before,  and  a  thorough  spinal  and  general  treatment 
is  given  for  the  constitutional  symptoms.  This  should  include 
treatment  to  the  blood  and  nerve-supply  of  the  breasts^  ovaries, 


128  PRACTICE    OF    OSTEOPATHY. 

and  testacles  to  prevent  metastasis,  which  is  probably  usually 
due,  in  part,  to  lesions  affecting  these  parts,  and  rendering  them 
liable  to  this  invasion.  Such  should  be  looked  to.  This  point 
must  not  be  neglected,  as  the  inflammation  may  be  driven  by 
the  treatment  to  these  parts.  By  thorough  treatment  of  them 
the  danger  of  metastasis  is  much  lessened.  Thorough  general 
treatment  prevents  the  serious  sequelae  that  sometimes  follow 
parotitis,  such  as  disorders  of  the  eye,  ear,  optic  nerve,  album- 
inuria,  arthritis,  facial  paralysis,  hemiplegia,  etc.  Careful  nursing 
and  care  of  the  patient  are  necessary  to  prevent  relapse.  The 
patient  should  remain  in  bed  during  the  acute  attack.  Hot  or 
cold  applications  to  the  gland,  and  support  with  cotton  and  a 
bandage,  afford  relief. 

PHARYNGITIS,  (Sore  Throat.) 

DEFINITION:  Acute  Pharyngitis  is  an  acute  catarrhal  in- 
flammation of  the  mucous  membrane  lining  the  pharynx. 

Chronic  Pharyngitis  is  a  chronic  catarrhal  condition  of  the 
membrane,  with  hypertrophy  or  atrophy  of  the  follicles.  It 
may  be  a  chronic  naso-pharyngeal  catarrh,  chronic  hypertrophic 
pharyngitis  (pharyngitis  sicca),  or  follicular  or  granular  pharyn- 
gitis. 

CASES:  (1)  Chronic  pharyngitis  in  a  professional  singer. 
The  voice  was  impaired,  the  patient  being  hardly  able  to  speak 
above  a  whisper.  Lesion  of  one  of  the  middle  cervical  vertebra 
was  found.  Treatment  to  it  cured  the  case. 

(2)  Acute    pharyngitis    and    stomatitis.     The    throat    was 
ulcerated.     The   usual  medical  treatment,   tried  for  a  number 
of  days,  was  unsuccessful.     The  patient  could  not  eat  for  sixteen 
days.     He  was  enabled  to  eat  by  two  osteopathic  treatments, 
and  the  case  was  cured. 

(3)  A  case  of  chronic  pharyngitis,  showing  lesion  as  marked 
tension  and  rigidity  of  the  ligaments  along  the  entire  cervical 
region,  with  tenderness  at  the  2d  and  3d  vertebrae.     Chronically 
enlarged  tonsils  were  present.     Both  conditions  were  cured  by 
restoring  normal  anatomical  conditions  in  the  cervical  region. 

(4)  Pharyngitis,    chronic,    caused    by    reflex    irritation    by 
lesion  at  the  fourth  right  rib,  which  was  twisted  at  its'articula- 


PRACTICE    OF    OSTEOPATHY.  129 

tion.  The  rib  was  replaced  and  the  trouble  disappeared,  not 
having  returned  at  a  time  six  years  later. 

LESIONS  AND  ANATOMICAL  RELATIONS:  These  conditions 
are  at  once  seen  to  be  catarrhs..  They  are  closely  associated 
with  nasal  catarrh,  and  with  tonsillitis.  Largely  the  same  nerve 
and  blood-supply  suffers  in  pharyngitis  as  in  these  conditions, 
hence  the  remarks  made  concerning  lesions  and  anatomical  re- 
lations in  considering  them  will  apply  with  equal  force  to  this 
disease. 

The  nerve-supply  to  the  mucous  membrane  of  the  pharynx 
is  from  the  pharyngeal  plexus,  composed  of  branches  from  the 
glosso-pharyngeal,  pneumogastric,  spinal  accessory,  and  cer- 
vical sympathetic.  The  sympathetic  supply  is  from  the  superior 
cervical  ganglion.  It  has  already  been  discussed  how  cervical 
ajid  upper  dorsal  lesion  affects  this  nerve  mechanism.  Under 
certain  conditions  it  is  readily  seen  that  the  vaso-motor  equili- 
brium of  the  pharyngeal  mucous  membrane  would  be  upset,  the 
lesion  directly  causing  the  inflamed  condition,  or  weakening  it 
and  laying  it  liable  to  the  effects  of  cold,  exposure,  tobacco,  a 
depraved  constitution,  gout,  scrofula,  overuse,  etc.,  commonly 
regarded  as  the  active  cause  of  the  condition. 

It  is  significant  from  the  osteopathic  point  of  view  that  ex- 
posure causes  the  condition,  and  that  the  neck  is  stiff  and  sore. 

The  hyoid  bone  is  sometimes  drawn  back  against  the  pneu- 
mogastric nerve  by  contraction  of  the  hyoid  muscles,  irritating 
this  nerve,  and  through  it  causing  pharyngitis.  This  is  a  very 
common  condition  in  people  using  the  voice  to  excess,  such  as 
public  speakers  and  singers.  Almost  without  exception  these 
cases  show  marked  contracture  of  the  upper  hyoid  muscles  es- 
pecially. It  is  common,  in  these  cases,  to  notice  marked  improve- 
ment after  a  few  minutes  treatment  directed  to  the  relaxation  of 
these  muscles.  In  some  cases  lesions  of  the  cervical  vertebrae 
cause  spasmodic  contractions  in  these  throat  muscles,  resulting 
in  pharyngitis  in  this  way. 

Upper  rib  and  clavicle  lesion  is  sometimes  present,  derang- 
ing sympathetic  connections  and  impeding  circulation  from  the 
throat.  The  clavicle  may  be  back  against  the  pneumogastric 
nerve.  Dr.  Still  holds  this  to  be  one  of  the  commonest  causes  of 


130  PRACTICE    OF    OSTEOPATHY. 

irritation  in  the  throat.  He  also  points  out  in  these  cases  lesions 
of  the  first  rib,  sometimes  at  its  sternal  end.  but  especially  at  its 
head. 

Atlas,  axis,  and  upper  cervical  lesions  are  the  most  frequent, 
but  lesion  may  be  found  anywhere  in  the  cervical  region.  The 
former  act  chiefly  by  affecting  the  superior  cervical  ganglion. 

As  pharyngitis  is  frequently  associated  with  digestive  dis- 
turbances one  sometimes  meets  lesion  in  the  splanchnic  area 
causing  pharyngitis  indirectly  in  this  way.  In  some  cases  various 
kinds  of  lesions,  causing  depraved  constitutional  conditions, 
may  be  the  ones  present.  It  is  interesting  in  this  connection,  to 
note  that  many  persons  who  have  suffered  from  la  grippe,  etc.,  can 
be  made  to  cough  by  spinal  manipulation  between  the  shoulders, 
which  affects  the  vagus  nerve  through  spinal  sympathetic  con- 
nections. Lesions  are  usually  present  here. 

One  case  of  aphonia  was  cured  by  reduction  of  lesion  between 
first  and  second  parts  of  the  sternum. 

The  PROGNOSIS  is  favorable,  good  results  being  almost 
uniformly  gained.  The  acute  case  is  at  once  greatly  relieved, 
and  is  cured  in  a  few  treatments.  Chronic  cases  are  often  en- 
tirely cured.  They  are  more  frequently  presented  for  treatment 
than  are  the  acute.  Relief  is  at  once  apparent  under  the  treat- 
ment. 

The  TREATMENT  is  mainly  that  pointed  out  in  detail  for 
Catarrh  and  Tonsillitis,  q.  v.  Thorough  correction  of  lesion, 
freeing  of  the  circulation,  and  relaxation  of  the  tissues  is  to  be 
accomplished.  Removal  of  specific  lesion  is  often  able  at  once 
to  cure  the  case.  One  must  make  a  special  point  of  keeping  re- 
laxed the  tissues  of  the  throat  from  the  angles  of  the  jaws  to  the 
clavicle.  This  frees  the  circulation.  Likewise  the  clavicle  should 
be  raised.  The  circulation  in  the  pharyngeal  plexus  is  also  much 
relieved  by  the  inward  mouth  treatment.  It  is  well  to  extend 
this  well  up  to  the  openings  of  the  Eustachian  tubes,  as  in  this 
way  one  may  prevent  the  inflammation  spreading  to  affect  the 
ears.  The  work  beneath  the  angles  of  the  jaws'  externally,  and 
opening  the  mouth  against  resistance  are  particularly  good  treat- 
ments in  this  condition.  Sore  throat  and  cough  are  often  much 
relieved  by  grasping  the  larynx  between  thumb  and  fingers  and 


PRACTICE    OF   OSTEOPATHY.  131 

applying  a  rapid  shaking  movement  to  it,  extending  the  treat- 
ment down  along  the  trachea  as  far  as  the  sternum. 

In  the  acute  case  the  patient  may  suck  ice  for  relief.  A  hot 
foot-bath  is  good.  The  diet  should  be  liquid  or  semisolid. 

Daily  sponge  baths  should  be  used,  with  first  tepid  and  then 
cool  water,  to  harden  the  skin. 

In  all  cases  the  active  source  of  irritation  must  be  removed. 
This  is  often  bony  lesion.  If  it  be  smoking,  the  use  of  alcohol, 
etc.,  it  must  be  dispensed  with. 

The  chronic  case  usually  calls  for  a  thorough  course  of  treat- 
ment to  enable  one  to  overcome  the  chronic  inflamed,  hyper- 
trophied  or  atrophied  condition  of  the  membrane. 

The  corrected  blood-supply  loosens  and  dispels  the  muco- 
purulent  secretions,  "and  normalizes  the  secretory  function. 
It  heals  the  ulcerations,  builds  up  the  atrophied  membrane,  or 
absorbs  the  hypertrophied  follicles. 

Constitutional  treatment  is  often  necessary. 

ESOPHAGITIS. 

DEFINITION:  An  acute  inflammation  of  the  mucous  lining 
or  the  submucous  coat  of  the  esophagus. 

CASES:  (1)  A  case  in  which  the  inflammation  of  stomatitis 
extended  downward  into  the  esophagus.  There  was  contracture 
of  the  supra-hyoid  muscles,  drawing  the  bone  back  against  the 
pneumogastric  nerve. 

(2)  A  case  in  which  irritation  the  length  of  the  esophagus, 
and  a  distressed  feeling  of  the  stomach,  were  due  to  a  posterior 
condition  of  the  upper  4  or  5  dorsal  vertebrae.  Correction  of  this 
lesion  removed  the  irritation  and  relieved  the  stomach. 

LESIONS  AND  ANATOMICAL  RELATIONS:  The  lesions  are 
often  the  same  as  those  for  stomatitis  and  pharyngitis,  as  this 
condition  is  often  due  to  extension  of  inflammation  downward 
from  above.  Thus  lesion  to  the  hyoid  bone,  to  the  muscles  of 
the  throat,  to  the  clavicle  and  upper  ribs  are  all  likely  to  occur. 
Lesion  to  the  clavicle  and  1st  rib  may  interfere  with  the  circula- 
tion to  the  esophagus  via  the  subclavian  and  thyroid  axis.  The 
various  cervical  lesions  already  discussed  as  capable  of  deranging 
the  activities  of  the  pneumogastric  and  sympathetic,  both  of 


132  PRACTICE    OF    OSTEOPATHY. 

which  unite  in  forming  the  esophageal  plexus,  may  react  upon  the 
esophagus. 

The  esophageal  plexus  is  in  connection  with  the  pulmonary 
plexus  and  thoracic  sympathetic.  Thus  is  seen  the  close  con- 
nection between  upper  spinal  lesion,  common  in  derangement 
of  the  esophagus,  and  its  sympathetic  innervation,  having  charge 
of  its  circulation.  Spinal  lesion  in  this  way  affects  the  circula- 
tion from  the  aorta  to  the  esophagus. 

The  cause  is  frequently  traumatic,  and  no  special  lesion  is 
present. 

The  PROGNOSIS  is  good.  Cases  usually  recover  in  a  few 
days;  often  spontaneously.  Generally  one  or  two  treatments 
are  all  that  are  required.  In  the  suppurative  form,  perforation, 
gangrene,  or  late  stricture  is  apt  to  end  in  death. 

The  TREATMENT  is  simple.  Any  cause  of  irritation,  me- 
chanical, thermal,  or  chemical  must  be  removed.  The  circu- 
lation is  corrected  and  the  inflammation  reduced  by  correction 
of  lesion,  treatment  of  the  upper  dorsal  region,  elevating  the  upper 
ribs  and  clavicle,  and  freeing  the  circulation  through  the  neck 
and  about  the  throat.' 

If  due  to  catarrh,  infectious  fevers,  etc.,  treatment  must 
be  made  accordingly. 

A  bland  diet,  especially  of  milk,  is  recommended.  In  seri- 
ous cases  rectal  alimentation  may  be  necessary.  Small  pieces 
of  ice  may  be  swollowed.  Warm  demulcent  drinks  are  good. 

In  chronic  cases  the  treatment  must  be  more  persistent. 
Any  source  of  continued  irritation  must  be  removed.  This  form 
is  often  due  to  passive  congestion  from  chronic  heart  or  kidney 
diseases,  and  attention  must  be  then  given  to  the  primary  con- 
dition. 

SPASM  AND  STRICTURE  OF  THE  ESOPHAGUS. 

CASES:  (1)  A  man,  aged  fifty,  suffered  from  a  constriction 
of  the  esophagus,  which  occurred  while  eating.  The  physician 
allayed  the  intense  pain  by  injection  of  morphine,  but  was  un- 
able to  overcome  the  obstruction.  The  case  became  serious. 
An  Osteopath  was  called  and  after  several  hours  effort  relieved 


PRACTICE    OF   OSTEOPATHY.  133 

the  condition.  The  case  was  treated  for  two  weeks  and  all  effects 
of  the  trouble  disappeared. 

(2)  A  case  of  constriction  of  the  esophagus  cured  by  treat- 
ment to  the  pneumogastric  nerves  and  in  the  upper  dorsal  region. 

The  LESIONS  in  these  cases  are  usually  upper  rib  and  upper 
thoracic  vertebral  ones. 

There  are  many  of  the  cases  which  present  no  special  bony 
lesion,  but  are  due  to  other  causes,  as  when  spasm  depends  en- 
tirely upon  a  nervous  reflex,  e.  g.,  from  the  uterus,  etc.,  or  when 
stricture  is  due  to  congenital  narrowing  or  to  constrictive  growth 
after  burning  with  a  corrosive  fluid. 

Yet  it  is  evident  that  a  reflex  irritation  from  a  rib  or- ver- 
tebral lesion  upon  the  direct  nerve-connections  of  the  esophagus 
could  be  quite  as  effectual  as  a  reflex  irritation  from  the  uterus 
in  causing  spasm  of  the  esophagus.  Specific  bony  lesion  may 
be  the  determining  cause  of  the  spasm  in  cases  of  hysteria,  chorea, 
epiliepsy,  etc. 

In  case  of  stricture  the  bony  lesion  may  be  the  ultimate 
cause  of  the  epithelioma,  polypus,  or  ulcers  and  cicatrix  finally 
resulting  in  stricture. 

The  PROGNOSIS  for  spasm  is  good.  It  is  commonly  easily 
overcome  by  the  treatment.  The  prognosis  for  stricture  is  not 
favorable.  It  is  a  surgical  case,  and  usually  can  be  relieved  only 
by  passing  a  bougie. 

The  TREATMENT  depends  upon  the  cause.  In  cases  of  spasm, 
if  a  nervous  disease  be  present  it  must  be  carefully  treated.  All 
cause  of  irritation  must  be  removed.  Rib  and  vertebral  lesion 
must  be  adjusted.  Thorough  treatment  in  the  upper  dorsal, 
lower  cervical,  and  upper  thoracic  region  is  quite  successful. 

In  cases  of  stricture  the  diet  should  be  semi-solid  or  fluid, 
and  concentrated.  Rectal  feeding  may  become  necessary. 
Osteopathic  treatment  as  above  may  be  applied,  but  it  is  likely 
that  the  bougie  will  have  to  be  used. 

ACUTE  AND  CHRONIC  GASTRITIS. 

DEFINITION:  The  acute  form  is  an  acute  catarrhal  inflam- 
mation of  the  mucosa  of  the  stomach;  acute  indigestion.  The 
chronic  form,  chronic  dyspepsia,  is  associated  with  structural 


134  PRACTICE    OF    OSTEOPATHY. 

changes  in  the  mucosa,  and  with  change  in  the  secretions  and 
muscular  activity  of  the  stomach. 

CAUSES:  Lesions  have  been  noted  in  various  cases  as  fol- 
lows: (1)  2d  to  6th  cervical  vertebrae  to  the  right;  2nd  cervical 
anterior;  8th  to  10th  dorsal  vertebrae  separated;  break  at  the 
fifth  lumbar.  (2)  Luxation  of  the  8th  rib;  tenderness  at  the  8th 
dorsal  vertebrae.  (3)  Cervical  and  dorsal  curvatures  of  spine, 
and  luxation  of  the  ribs. 

(4)  A  case  of  catarrhal  gastritis  in  a  man  sixty-four  years 
of  age,  of  twenty  years  standing.     The  patient  was  unable  to 
take  nourishment.     Lesion  was  of  the  4th  and  5th  right  ribs, 
which  were   slipped   at   their  vertebral   articulations.     The  pa- 
tient was  able  to  get  up  on  the  fifth  day  of  treatment  and  re- 
turned to  work  in  three  weeks.     The  ribs  were  entirely  corrected 
in  two  months. 

(5)  Chronic  gastritis  due  to  a  downward  displacement  of 
the  right  fifth  rib.     The  lesion  was  corrected  and  the  case  cured. 

These  cases,  almost  without  exception,  show  lesion  in  the 
upper  splanchnic  region,  between  the  shoulders,  including  the 
spinal  area  from  the  second  to  the  seventh  dorsal.  A  common 
form  is  flatness  or  anterior  position  of  this  region.  Its  tissues  are 
often  sore  or  sensitive  under  pressure.  The  soreness  may  appear 
only  coincidentally  with  more  acute  manifestations  of  the  stomach 
disorder,  or  it  may  be  better  and  worse  according  to  the  condi- 
tion of  that  organ. 

Lesions  at  the  atlas,  axis  and  third  cervical  affect  the  vagus 
nerve  through  its  connection  with  the  superior  cervical  ganglion. 
It  may  be  obstructed  along  its  course  in  the  neck.  Lesions  to 
the  cervical  region  and  to  the  pneumogastric  nerves  in  the  neck 
are  of  secondary  importance  in  causing  stomach  disease.  The 
main  lesions  occur  in  the  spine,  affecting  the  splanchnic  area, 
and  may  be  of  the  ribs  and  their  cartilages,  of  the  vertebrae,  or 
of  the  spinal  and  intercostal  muscles  and  other  tissues  mentioned. 
Lesions  to  these  structures  occur  mainly  between  the  fourth  and 
tenth  dorsal  region,  but  may  occur  either  a  little  above  or  below 
these  limits.  The  pneumogastrics  and  the  splanchnics  both 
contribute  to  the  solar  plexus,  which  has  charge  of  the  functional 
activities  of  the  organ.  The  wide  area  of  origin  of  the  splanchincs 


PRACTICE    OF   OSTEOPATHY.  135 

along  the  spine,  and  their  importance  in  the  innervation  of  the 
stomach,  accounts  for  the  fact  that  lesions  to  this  area  are  most 
potent  in  producing  derangement.  At  the  -same  time  this  is  so 
readily  accessible  to  the  Osteopath's  work  that  results  are  gen- 
erally easily  attained  in  the  treatment  of  such  troubles. 

Lesions  to  ribs  and  cartilages  act  in  part  through  inter- 
ference with  the  intercostal  nerves,  which  are  in  direct  sympa- 
thetic connection  with  the  solar  plexus  through  the  splanchnics. 
Luxation  of  the  ribs  may  also  interfere  with  spinal  nerves  by 
derangement  of  the  tissues  about  the  head  of  the  rib.  Lesions 
of  spinal  muscles,  ligaments,  and  vertebrae  act  mainly  through 
interference  with  the  spinal  nerves  and  thus  upon  the  connected 
splanchnics.  Muscular  lesion  may  often  be  secondary  to  stomach 
disease,  but  in  such  case  indicates  the  point  of  treatment,  and 
may  point  to  spinal  lesion  at  that  place.  The  vagi  nerves  carry 
sensory,  motor  and  secretory  fibers  to  the  stomach.  The  splanch- 
nics contain  vaso-motor  and  viscero  inhibitory  fibers  for  the 
stomach.  But  as  the  influence  of  the  abdominal  brain  is,  accord- 
ing to  Robinson,  supreme  over  visceral  circulation,  and  controls 
as  well  visceral  secretion  and  nutrition,  the  results  of  our  treat- 
ment upon  the  pneumogastrics  and  the  splanchnics  must  affect 
the  stomach  mainly  through  the  solar  plexus.  As  the  splanch- 
nics contain  these  vaso-motors  for  the  stomach,  the  main  treat- 
ment for  gastritis,  a  vaso-motor  disturbance,  must  be  through 
them.  Lesions  to  the  splanchnic  area  are  likely  to  cause  gas- 
tritis upon  account  of  their  being  the  vaso-motors. 

McConnell  states  that  lesion  of  the  eighth  and  ninth  cos- 
tal cartilages  may  cause  gastritis. 

The  mechanical  irritation  of  coarse,  poorly  masticated  food, 
the  fermentation  of  over-ripe  fruit  in  the  stomach,  and  the  effects 
of  constant  overloading  of  the  stomach  and  of  indiscretion  in 
diet,  may  irritate  the  mucosa  and  cause  gastritis  in  the  absence 
of  specific  lesion.  But  in  such  cases  secondary  lesions  are  gen- 
erally produced  by  the  trouble.  In  the  ordinary  case  of  gastritis 
some  causes  beyond  these  must  be  sought,  as  the  disease  so  fre- 
quently occurs  without  such  indiscretions. 

The  PROGNOSIS  for  recovery  is  good  in  both  acute  and 
chronic  cases.  The  ordinary  acute  case  is  relieved  immediately 


136  PRACTICE    OF    OSTEOPATHY. 

by  a  treatment.  More  than  one  treatment  may  not  be  necessary. 
In  chronic  cases,  even  when  severe  and  of  very  long  standing, 
relief  is  soon  given,  and  a  cure  can  usually  be  made. 

The  TREATMENT  must  be  directed  to  the  specific  lesion, 
generally  of  the  splanchnic  area,  that  is  causing  the  trouble. 
Its  main  object  must  be  to  correct  the  circulation,  and  thus  to 
take  down  the  inflamed  condition  of  the  mucosa  and  restore 
normal  secretion.  The  splanchnics  and  solar  plexus,  having 
charge  of  the  circulation  and  secretion,  afford  a  most  convenient 
means  of  doing  this.  The  correction  of  lesion  here,  and  the  treat- 
ment given  the  splanchnics  and  solar  plexus  in  conjunction  with 
the  removal  of  lesion  constitute  the  main  treatment  in  such  cases. 

With  the  patient  lying  upon  his  side  or  upon  his  face,  the 
muscles  and  deep  tissues  of  the  splanchnic  area  are  thoroughly 
treated  and  relaxed.  The  patient  now  lies  upon  his  side,  or  sits 
up,  and  treatment  is  given  the  spinal  vertebrae  and  ribs  of  this 
region.  The  former  are  thoroughly  treated  and  sprung,  to  relax 
all  their  related  tissues  and  remove  obstructions  to  the  nerves. 
The  latter  are  raised,  and  adjusted  in  case  of  lesion,  to  aid  in  this 
process.  Vaso-motor '  activity  is  thus  aroused  and  corrected. 
This  important  process  is  aided  by  deep  treatment  of  the  solar 
plexus  from  the  abdominal  aspect.  (VI.  Chap.  VIII).  As  this 
plexus  has  the  main  control  of  visceral  circulation  and  secretion, 
treatment  of  it  rouses  and  normalizes  its  functions.  Mechanical 
pressure  of  displaced  ribs  upon  the  stomach  may  be  found.  The 
upper  abdominal  treatment  aids  circulation  in  the  stomach.  (V. 
Chap.  VIII).  Attention  is  given  the  upper  cervical  region  for 
lesions  affecting  the  vagus.  It  may  be  treated  in  the  neck  as 
a  means  of  aiding  the  general  treatment.  Inhibition  by  pressure 
upon  the  left  vagus  relaxes  the  pylorus.  This  pressure  may 
be  made  in  the  neck  directly  upon  the  nerve,  or  may  be  made 
at  the  third  or  fourth  intercostal  space  near  the  spine.  This 
latter  treatment  is  much  used  to  relieve  nausea  and  vomiting. 
Its  effect  is  probably  through  the  sympathetic  connections  with 
the  vagus.  In  some  cases  pressure  at  this  intercostal  space  has 
caused  vomiting.  In  some  cases  abdominal  manipulation  in- 
duces vomiting.  This  should  be  encouraged  to  relieve  the  stomach 
of  its  irritating  contents.  Excessive  vomiting  should  be  checked. 


PRACTICE  OF  OSTEOPATHY.  137 

Thorough  treatment  along  the  spine  (splanchnic  area)  will  aid 
in  this.  After  inhibition  of  the  left  vagus  to  relax  the  pylorus, 
the  patient  may  be  placed  upon  his  right  side  and  deep  pressure 
be  made  over  or  beneath  the  left  hypochondrium,  from  the  cardiac 
toward  the  pyloric  end,  to  aid  in  the  passage  of  t'he  stomach  con- 
tents into  the  intestine. 

McConnell  states  that  inhibition  at  the  Sth  and  9th  dorsal 
relaxes  the  pylorus;  inhibition  at  the  6th  and  7th  dorsal  relaxes 
the  cardiac  orifice.  He  has  found  that  correction  of  lesion,  in 
the  lower  left  ribs  aids  in  the  absorption  of  gas.  Deep  pressure 
over  the  solar  plexus  also  aids  this  process. 

Liver,  bowels,  and  kidneys  must  be  kept  in  active  condi- 
tion by  treatment.  The  patient  should  be  absteminous  in  diet. 
It  should  be  light  and  easily  digested,  and  may  be  according  to 
prescribed  dietaries.  The  patient  should  masticate  thoroughly 
He  must  avoid  fats,  alcohol,  and  sweets.  In  severe  cases  he 
•should  be  put  upon  a  milk  diet. 

Acute  cases  should  be  treated  frequently,  chronic  cases 
three  times  per  week. 

DISEASES  OF  THE  STOMACH  (Continued.) 
CASES'  (1)  Strain  from  heavy  lifting,  followed  by  severe 
lameness  at  the  time,  which  gradually  disappeared.  In  a  few 
months  severe  stomach  disease  followed;  no  food  could  be  re- 
tained, and  rectal  feeding  was  resorted  to.  Patient  came  under 
treatment  too  weak  to  walk  or  talk.  Muscular  contractures 
under  the  right  shoulder  and  a  slightly  displaced  rib  were  the 
lesions  found.  They  are  corrected  and  the  case  was  cured. 

(2)  Ulceration  of  the  stomach  and     complication  of  troubles, 
due   to   spinal   curvature.     Correction   of   curvature  gave  great 
relief. 

(3)  Ascidity  of  the  stomach  and  diarrhoea,  caused  by  ab- 
normal tension  in  the  spinal  tissues.     Cured. 

(4)  Gastralgia:  attacks  so  severe  that  they  induced  spasm 
in  abdominal  and  neck  muscles  at  the  same  time.     The  spasm 
was  always  stopped  at  once  by  inhibition  of  the  solar  plexus  and 
of   the   posterior  cervical   nerves.     Attacks  grew  less  frequent 
under  treatment. 

(5)  Gastralgia;  agonizing  pain  followed  taking  even  small 


138  PRACTICE    OF   OSTEOPATHY. 

quantities  of  food  as  long  as  it  remained  in  the  stomach.  6th, 
7th,  and  8th  right  ribs  were  down.  These  being  replaced  the 
trouble  disappeared. 

(6)  Gastralgia   of   several   years  duration.     Lesions   at    5th 
and  6th  dorsal  and  2d  lumbar  vertebrae.     Luxation  of  the  8th 
right  rib.     Case  cured  by  four  month's  treatment. 

(7)  Gastralgia;  three  years  standing;  attacks  after  nearly 
every  meal.     Lesion,  a  lateral  twist  of  the  6th  dorsal  vertebra. 
Cured  in  one  year's  treatment. 

(8)  Gastralgia;   incessant   pain   in   left   side,   stomach,    and 
bowels;  4th  and  5th  right  and  left  ribs  drawn  together;  8th  left 
under  7th;  spinal  muscles  tense.     Great  relief  was  given  by  one 
month's  treatment. 

(9)  Gastralgia.     Seventh  dorsal  vertebra  right ;  great   ten- 
sion at  the  12th  dorsal. 

(10)  Gastralgia.     Lesions  at  atlas  and  4th  dorsal. 

(11)  Gastralgia.     Luxation  of  the  llth  rib. 

(12)  Tenderness    over    the    stomach     (hypenethesia) :    8th 
dorsal  vertebra  very  tender  and  8th  rib  luxated;  cured  by  two 
weeks  treatment. 

(13)  Dilatation  of  the  stomach  and  a  complication  of  dis- 
eases.    The  spine  was  straight  and  flat ;  thorax  flat ;  2d  and  3rd 
cervical  vertebrae  lateral;  left  cervical  muscles  tense;  slight  lateral 
curvature  to  left  between  the  5th  dorsal  and  3rd  lumbar;  spinal 
muscles  tense. 

(14)  A  case  of  chronic  dilatation  of  the  stomach  of  some 
years   standing,    with   constipation   and   gastric   pain.     The   ap- 
petite was  ravenous  at  times,  at  times,  but  taking  food  aggravated 
the  pain.     The  case  was  cured  in  5  months,  the  weight  having 
increased  from  104  to  158  pounds. 

(15)  Chronic   nervous   dyspepsia   of   twenty   years   standing 
in  a  man  of  42.     The  stomach  was  dilated,  and  pain  was  present 
two  hours  after  eating.     Lesion  was  posterior  condition  of  6th 
and  7th  cervical;  lower  dorsal  and  upper  lumbar  markedly  pos- 
terior; compensatory  anterior  swerve  of  the  upper  dorsal  region. 
The  case  was  cured  in  eight   months. 

(16)  A   severe   acute   attack   of   pain   in   the   stomach   with 
nausea    and    constant    vomiting   for   48   hours.     Medicine   gave 


PRACTICE    OF    OSTEOPATHY.  ISO 

no  relief.  One  treatment  greatly  relieved  the  case,  and  in  three 
days  the  patient  was  at  work. 

(17)  Gastric  colic  in  a  man  of  forty,  resulting  from  injuries 
received  six  years  previously,  in  which  the  spine  was  injured, 
and  the  lower  right  ribs  were  pressed  inward.  The  first  attack 
The  first  attack  of  pain  occurred  2  months  after  the  accident, 
marked  by  severe  pain  and  cramping  in  the  right  side  above  the 
crest  of  the  ilium,  radiating  upward.  Attacks  every  10  days, 
and  accompanied  by  extreme  nausea  and  vomiting.  The  pa- 
tient was  confined  to  bed  three  of  four  days  at  each  attack.  At 
times  the  cramping  was  so  severe  as  to  extend  to  all  the  mus- 
cles of  the  body. 

Lesion  was  present  as  anterior  condition  of  the  fourth  dor- 
sal vertebra.  The  lumbar  portion  of  the  spine  was  prominently 
posterior.  The  condition  of  the  ribs  was  as  above  noted.  Kid- 
neys and  liver  were  involved. 

After  the  3d  treatment  the  patient  was  benefited.  The 
attacks  grew  less  severe  and  less  frequent.  The  case  was  prac- 
tically cured  at  the  time  of  the  report,  three  months  having 
elapsed  since  the  last  attack. 

LESIONS:  In  all  the  above  cases  the  splanchnic  area  was 
affected;  neck  lesion  was  rare,  and  apparently  of  secondary  im- 
portance; lesions  to  the  spine,  including  vertebrae  and  muscles 
were  important,  occurring  in  ten  of  the  cases;  rib  lesions  were 
the  most  important  and  specific,  occurring  in  seven  of  the  cases. 
Lesions  of  the  5th  to  8th  ribs  (area  of  greater  splanchnic)  occur 
most  frequently. 

Lesions  to  the  splanchnic  area,  through  rib  or  spinal  lesion, 
apparently  occur  in  all  cases  of  stomach  disease.  We  are  not 
yet  able  to  specialize  as  to  lesion,  and  say  that  one  particular 
style  of  lesion,  or  lesion  of  some  individual  rib  or  vertebra  causes 
a  certain  kind  of  stomach  disease. 

It  is  probable  that  in  the  future  compilation  of  lesions  may 
show  considerable  specialization  of  them  in  the  etiology  of  stomach 
disease.  But  it  is  also  likely  that  such  tabulation  will  indicate 
the  probabilities  only,  for  it  is  a  matter  of  experience  that  a 
given  lesion  will  produce  in  one  patient  one  form  of  stomach 
disease,  and  in  another  a  different  form,  depending  upon  indivi- 


140  PRACTICE    OF    OSTEOPATHY. 

dual  peculiarities,  and  upon  various  attendant  conditions.  Hence 
one  must  be  upon  the  lookout  for  any  various  lesions  in  the  splanch- 
nic area  in  all  stomach  diseases.  They  may  cause  a  predomi- 
nance of  sensory,  motor,  secretory,  or  vaso-motor  derangements, 
and  complications  thereof,  and  according  to  the  predominating 
difficulty  it  may  be  that  special  lesion  will  be  suspected,  or  that 
special  areas  will  be  treated  in  conjunction  with  the  removal  of 
specific  lesion  in  the  case. 

The  practitioner's  simple  duty  in  stomach  disease  is  most 
thorough  examination  of  the  splanchnic  region  of  the  spine, 
just  above  and  just  below,  and  of  the  thoracic  parts  in  relation 
thereto.  When  he  has  done  this  he  has  located  the  trouble, 
almost  invariably,  and  his  treatment  of  this  region,  removing 
the  lesion,  almost  as  generally  cures  or  benefits  the  case.  Le- 
sion outside  of  this  area  is  of  minor  importance,  and  treatment 
directed  elsewhere  (abdomen  and  neck)  is  either  secondary  or 
for  alleviation  merely. 

Special  lesions  have  been  noted  as  follows:  in  ascidity, 
the  lesser  splanchnics  and  the  4th  and  5th  dorsal  (A.  T.  Still) ; 
in  gastralgia,  frequent  luxation  of  the  8th  and  9th  ribs  anteriorly 
(McConnell) ,  also  of  the  5th,  6th  and  7th  dorsal;  for  gastric  ulcer, 
frequent  lesion  of  the  8th  and  9th  ribs  anteriorly,  and  of  the  5th 
to  8th  ribs  posteriorly  (McConnell.) 

Secondary  lesion  in  the  form  of  contracturing  of  spinal 
muscles,  particularly  along  the  splanchnic  area,  is  of  very  fre- 
quent occurrence  in  stomach  disease.  Although  in  this  case  the 
result,  and  not  the  cause,  of  stomach  disease,  it  is  of  much  im- 
portance osteopathically.  (1)  It  indicates  the  point  of  treat- 
ment, for  it  is  an  indication  upon  the  surface  of  the  body  of  what 
special  nerve  fibers  or  areas  are  suffering  derangement  by  the 
particular  form  of  disease  present.  There  is  a  direct  path  be- 
tween the  diseased  stomach  and  the  contractured  muscle,  over 
which  the  abnormal  impulses,  generated  in  the  stomach,  pass 
out.  It  is  Nature's  landmark  of  a  special  diseased  condition,  or 
of  a  phase  thereof.  Experience  shows  that  in  the  absence  of 
any  other  lesion  whatsoever,  treatment  at  the  point  of  contrac- 
ture  may  cure  the  condition.  It  is  evident  that  the  nerve  area 
thus  indicated  was  the  one  needing  treatment. 


PRACTICE    OF    OSTEOPATHY.  141 

(2)  These  contractures  do  not  always  occur  at  the  same 
location,  nor  always  affect  the  spinal  muscles  over  the  splanch- 
nic area  generally.  They  may  occur  upon  the  one  side  of  the 
spine  only,  high  up  in  the  splanchnic  area  or  above  it.  They 
must  therefore  indicate  lesion  in  different  nerve  areas  or  fibers, 
according  to  some  condition  present  and  determining  which  fibers 
shall  thus  suffer  and  produce  contracture.  It  is  possible  that 
they  indicate  seat  of  lesion  in  the  spine  not  otherwise  discover- 
able. In  such  case  this  weak  point  would  be  the  determining  con- 
dition in  the  location  of  the  situation  of  the  contracture.  Thor- 
ough treatment  at  this  point  may  restore  conditions  and  thus 
correct  lesion  which  is  important  in  the  causation  of  the  stomach 
disease.  Contracture  and  soreness  in  the  cervical  or  lumbar 
regions  may  follow  stomach  disease,  and  possibly  indicate  im- 
portant relations,  by  lesion  or  otherwise,  between  these  parts. 

ANATOMICAL  RELATIONS:  Robinson  states  that  the  solar 
plexus  is  supreme  over  visceral  circulation,  that  it  controls  also 
secretion  and  nutrition.  The  important  lesions  noted  in  stomach 
trouble  affect  its  spinal  connections,  the  splanchnics,  and  may 
therefore  cause  circulatory,  secretory,  or  nutritional  disturb- 
ances in  its  connected  organs.  Likewise  they  may  cause  sensory 
and  motor  troubles,  as  the  same  authority,  and  the  American 
Text-Book  of  Physiloogy,  as  well,  states  that  this  plexus  receives 
sensation  and  sends  out  motion.  According  to  Quain,  the  termi- 
nal branches  of  the  pneumogastric  unite  with  the  gastric  plexus 
of  the  sympathetic,  and  carry  motor  and  sensory  fibers  to  the 
stomach.  Flint  shows  that  the  pneumogastric  has  much  to  do 
with  gastric  secretions,  as  section  of  it  leads  to  almost  complete 
cessation  of  stomach  secretions.  It  is  considered  probable  by 
investigators  that  its  motor  function  in  the  stomach  is  derived 
from  its  sympathetic  connections.  Osteopathic  work  seems.  10  in- 
fluence it  more  largely  through  its  sympathetic  connections. 
It  is  treated  also  in  the  neck  directly.  It  is  important  in  sensory 
and  motor  diseases.  The  splanchnics  contain  vaso-and  viscero- 
motor  fibers.  Stimulation  of  the  planchnics  lessens  peristalsis; 
of  the  pneumogastrics  increases  it.  Thus  important  control  is 
gained  in  various  conditions.  Quain  states  that  sensory  nerves 
for  the  stomach  pass  from  the  dorsal  nerves  from  the  6th  to  the 


142  PRACTICE    OF    OSTEOPATHY. 

9th;  the  6th  and  7th  supplying  the  cardia,  the  8th  and  9th  the 
pyloric  end. 

The  PROGNOSIS  in  stomach  diseases  as  a  class  is  extremely 
good.  Many  severe  cases  of  long  standing  have  been  cured. 
As  a  rule  relief  is  immediately  given,  and  cure  follows. 

The  TREATMENT  of  stomach  diseases  as  a  class  is  very  simple. 
It  consists  mainly  in  corrective  treatment  in  the  splanchnic  area, 
together  with  a  certain  amount  of  neck  and  abdominal  work. 
This  is  supplemented  by  certain  special  treatments  for  various 
purposes  in  the  treatment  of  special  diseases.  Through  the 
pneumogastrics  and  the  sympathetic  connections,  the  solar 
plexus  and  the  splanchnics,  control  is  had,  to  a  marked  degree, 
over  the  processes  regulated  by  them;  sensation,  motion,  nutri- 
tion, secretion,  circulation.  Few  diseases  can  remain  after 
correction  of  these  functions  by  removal  of  the  lesion  disarrang- 
ing them. 

The  treatment  of  the  solar  plexus,  the  spine  (splanchnics), 
the  pneumogastrics,  and  the  removal  of  the  various  lesions  likely 
to  occur  in  these  regions  have  already  been  discussed. 

The  various  motor,  secretory,  and  sensory  neuroses,  de- 
scribed under  the  general  name  of  nervous  dyspepsia,  are  treated 
by  removal  of  special  lesion  and  by  the  work  for  the  control 
of  various  functions  as  discussed.  In  cases  of  supermotility, 
peristaltic  unrest,  and  nervous  eructation,  special  treatment 
may  be  given  to  stimulate  the  splanchnics  and  solar  plexus  to 
lessen  peristalsis.  In  nervojis  vomiting,  the  work  should  be 
directed  to  the  cerebral  centers,  by  treatment  in  the  superior 
cervical  region,  and  to  the  solar  plexus.  Strong  inhibition  to 
the  left  pneumogastric  in  the  neck  will  relax  the  pylorus  and 
aid  in  passing  the  stomach  contents  into  the  duodenum.  Deep 
pressure  at  the  3rd  and  4th  left  intercostal  space  near  the  spine 
will  relieve  nausea  and  stop  the  vomiting. 

In  spasm  of  the  cardia,  inhibition  should  be  made  at  the 
6th  and  7th  dorsal  for  fibers  controling  it.  while  in  spasm  of 
the  pylorus  the  inhibition  should  be  upon  the  8th  and  9th  dor- 
sal and  upon  the  left  vagus.  In  atony  of  the  stomach,  thorough 
stimulation  should  be  given  the  vagi,  splanchnics  and  solar  plexus, 
to  increase  muscular  tone  and  to  develop  circulation.  Local 


PRACTICE    OF    OSTEOPATHY.  143 

manipulation  over  the  region  of  the  stomach  would  aid  in  toning 
the  muscular  walls  (see  treatment  of  Gastritis.)  In  insufficiency 
of  the  cardia  stimulation  should  be  given  the  6th  and  7th  dorsal, 
while  in  pyloric  insufficiency  the  8th  and  9th  dorsal  and  the  left 
vagus  must  be  looked  to.  Local  stimulation,  by  brisk  work 
over  the  abdomen,  aids  the  operation. 

In  secretory  disturbances,  hyper-ascidity,  super-secretion, 
and  sub-ascidity,  work  upon  the  vagus  and  solar  plexus,  through 
the  splanchnics,  corrects  circulation  and  rights  secretion.  Stim- 
ulation of  the  lesser  splanchnics  and  of  the  4th  and  5th  dorsal 
is  important. 

In  sensory  disorder  attention  must  be  given  the  sensory 
innervation.  Hyperaesthesia  needs  a  general  stimulation.  Gas- 
tralgia  needs  deep  inhibition  at  the  solar  plexus,  splanchnics, 
and  vagi.  Special  inhibition  should  be  made  from  the  6th  to 
9th  dorsal,  8th  and  9th  ribs  anteriorly,  and  the  5th,  6th  and  7th 
dorsal  vertebrae,  all  of  which  points  seem  concerned  in  the  sen- 
sory innervation  of  the  stomach.  For  the  abnormal  sensations 
of  hunger,  lack  of  appetite,  etc.,  general  correction  of  secretions 
and  sensation  will  be  efficient. 

For  dilatation  of  the  stomach,  rapid  cutaneous  stimulation 
over  the  region  of  the  stomach  aids  in  contracting  its  muscular 
fibers.  Treatment  should  be  given  for  the  stimulation  of  the  vagi, 
and  accumulated  food  must  be  kept  worked  out  of  the  stomach. 
All  causes  of  obstruction  of  the  pylorus  should  be  removed. 
This  obstruction  may  be  of  such  a  nature  as  to  demand  surgical 
attention.  In  case  the  cause  be  overgrowth  of  tissue,  cancer, 
cicatrix  of  an  ulcer,  etc.,  an  attempt  may  be  made  to  relax  the 
pylorus  by  inhibition  of  the  vagus  (vide  supra),  and  to  pass  the 
food  on  through  the  stomach  by  manipulation  as  before  described. 
In  case  the  obstruction  of  the  pylorus  be  not  total  one  may  suc- 
ceed in  keeping  the  contents  of  the  stomach  passed  until  the 
course  of  treatment  can  reduce  the  cause  of  obstruction. 

Much  the  same  plan  must  be  followed  in  cases  in  which  the 
obstruction  is  due  to  external  compression,  or  from  growths, 
displaced  kidney,  gall-stones,  etc.  One  may  sometimes  easily 
remove  the  cause  of  obstruction. 

In  all  cases  not  due  to  pyloric  stenosis,  as  from  over-strain 


144  PRACTICE    OF    OSTEOPATHY. 

of  the  muscular  coats  by  repletion;  chronic  gastric  catarrh, 
weakening  the  muscle;  fatty,  and  other  forms  of  degeneration; 
congenital  weakness;  impaired  innervation,  etc.,  one  may  apply 
the  treatment  first  mentioned  above  for  dilatation,  always  with 
due  attention  to  the  cause  and  to  the  lesions  present. 

Careful  attention  to  the  diet  is  necessary.  It  should  be 
small  in  amount  at  a  time,  and  fluid  or  semi-fluid  or  semi-solid. 
In  this  way  the  food  is  soon  passed  through,  and  has  no  tend- 
ency to  dilate  the  organ  further  or  to  interfere  with  its  repair. 

A  thorough  abdominal  treatment  should  be  given  to  tone 
local  circulation.  Strengthen  the  abdominal  walls,  and  stim- 
ulate the  walls  of  the  stomach  itself.  (See  treatment  of  gas- 
tritis.) 

For  gastroptosis  one  should  apply  treatment  as  described  for 
enteroptosis,  q.  v. 

In  peptic  ulcer  attention  should  be  given  to  perfect  free- 
dom of  circulation.  The  condition  of  the  8th  and  9th  ribs  an- 
teriorly, and  of  the  5th  to  8th  ribs  posteriorly,  must  be  looked 
to.  Absolute  rest  is  necessary.  The  patient  should  remain 
abed,  and  rectal  feeding  be  resorted  to  in  part,  for  alimentation. 
The  diet  must  be  carefully  regulated,  and  of  a  sort  mostly  digested 
in  the  stomach.  Skimmed  milk,  butter-milk,  and  pancreatized 
milk  gruel  are  recommended.  The  latter  is  used  also  for  rectal 
injection.  A  diet  of  ice-cream  is  reported  as  having  cured  a 
number  of  cases. 

The  vomiting,  hematemesis  and  pain  may  be  controlled 
according  to  directions  given  for  those  conditions. 

The  removal  of  lesion  and  maintenance  of  a  free  circula- 
tion are  measures  greatest  importance,  as  thereby  the  ulcer 
is  healed.  As  a  derangement  of  the  secretions,  such  as  hyper- 
ascidity,  predisposes  to  ulcer,  it  is  seen  that  correction  of  circula- 
tion guards  against  it.  The  same  is  true  of  the  point  that  gas- 
tritis causes  ulcer. 

A  general  course  of  treatment  should  be  given  to  build  up 
the  health  of  the  body  and  to  improve  the  quality  of  the  blood 
in  such  conditions  as  anemia,  chlorosis,  and  amenorrhoea.  which 
favor  the  development  of  ulcers. 

In  hemorrhage  from  the  stomach  (Hematemesis) ;  inhibit  the 


PRACTICE  OF  OSTEOPATHY.  145 

splanchnics,  and  the  solar  plexus  carefully,  to  lessen  the  blood- 
pressure  for  the  general  vaso-motor  center,  and  make  deep  in- 
hibitive  treatment  of  the  abdomen  to  dilate  the  great  abdominal 
veins  and  call  the  blood  away  from  the  stomach.  One  should 
proceed  as  in  other  internal  hemorrhage.  (See  Pulmonary  Hem- 
orrhage). One  must  treat  the  condition  according  to  its  cause. 
If  it  be  from  local  disease,  such  as  ulcer,  the  first  measure  is  to 
stop  the  hemorrhage  as  above  directed.  The  same  remark  ap- 
plies to  hemorrhage  from  traumatic  causes.  If  the  cause  be  a 
mechanical  impedment  to  the  portal  vein,  this  should  be  removed; 
if  vicarious  menstruation,  the  local  hemorrhage  of  the  stomach 
must  be  first  controlled,  while  later  treatment  looks  to  the  re- 
establishment  of  menstruation. 

In  the  treatment  of  hemorrhage  from  the  stomach,  the  or- 
gan must  be  given  absolute  rest.  Rectal  feeding  may  be  re- 
sorted to  for  this  purpose.  Cold  applications  may  be  made  over 
the  region  of  the  stomach.  The  patient  must  remain  quietly 
upon  his  back.  No  stimulants  should  be  administered. 

In  cancer  of  the  stomach,  general  corrective  work  and  par- 
ticular attention  to  freedom  of  circulation  must  be  relied  upon. 
(See  treatment  of  "Tumors.") 

Look  for  lesion  to  any  of  the  special  points  mentioned  in 
relation  to  the  various  diseases.  The  bowels,  kidneys  and  liver 
must  be  kept  in  free  action.  The  diet  should  in  all  cases  be  lim- 
ited and  easily  digested. 

CONSTIPATION. 

DEFINITION:  "Infrequent  or  incomplete  alvine  evacua- 
tion, leading  to  retention  of  feces"  (Quain).  "A  neurosis  of 
the  fecal  reservoir"  (Bryon  Robinson).  Osteopathically  it  is 
regarded  as  a  neurosis  due  to  obstructed  action  of  the  nerves 
supplying  the  bowel  with  secretion,  motion,  and  circulation. 
It  may  be  symptomatic  of  other  disease,  or  a  complication. 
It  is  very  frequent  idiopathic,  due  to  specific  lesion  to  bowel 
innervation. 

CASES  have  presented  various  lesions;  (1)  Contraction  of 
the  sigmoid  flexure,  (2)  Spinal  lesions,  mostly  in  the  lumbar, 
causing  spinal  cord  disease  and  partial  paralysis  of  limbs  and 
bowel,  (3)  A  posterior  prominence  of  the  whole  lumbar  region, 

10 


146  PRACTICE    OF    OSTEOPATHY. 

(4)  Lesion  at  5th  and  6th  dorsal,  2nd  lumbar,  and  8th  right  rib, 

(5)  At  3rd  and  4th  dorsal,  9th  dorsal,  5th  lumbar,  (6)  Intense 
contraction  of  the  external  sphincter  ani,  (7)  Slight  parting  of 
1st  and  2nd  lumbar,   (8)  Prolapsus  of  the  sigmoid,   (9)  Retro- 
version  of  the  uterus  against  the  rectum,   (10)  Right  curve  of 
spinal  column;  3rd  to  6th  dorsal    vertebra?  posterior;  7th  to  10th 
dorsal  vertebrae  anterior  and  flat;  llth  and  12th  dorsal  and  1st 
lumbar  posterior;  12th  dorsal  and  1st  lumbar  the  seat  of  pain; 
12th  rib  down;  2nd  and  3rd  lumbar  close;  5th  lumbar  sore  and 
anterior.     (11)  2nd  and  3rd  dorsal  separated,  3rd  and  4th  to- 
gether,   3rd  to  5th  flat,    6th  to    the  left,    llth  dorsal   to  2nd 
lumbar  posterior,    (12)   6th    and  7th   dorsal    posterior,    9th   to 
12th  flat,  ribs  irregular  and  prominent  on  the  left,  (13)  Coccyx 
badly  bent,  lesion  of  5th  lumbar,  (14)  Separation  between  verte- 
brae from   8th  to    10th    dorsal,   and   between  5th  lumbar  and 
sacrum,  (15)  2nd  to  5th  dorsal  approximated  and  to  the  right, 
separations  between  vertebrae  from  8th  dorsal  to  3rd  lumbar, 
the  right  innominate  up  and  back,  (16)  Spine  rigid;  atla.s  to  the 
left;  2d,  3d,  and  4th  cervical  vertebrae  to  the  right;  12th  dorsal 
posterior;  llth  rib  overlapping  the  9th  and  10th,  (17)  6th  dorsal 
anterior;  4th  and  5th  lumbar  to  the  right;  spine  stiff  from  6th 
dorsal  to  4th  lumbar;  right  innominate  posterior;  12th  rib  dis- 
placed upward,  at  its  anterior  end,  under  the  12th,  (18)  Lateral 
lesion  of  10th  dorsal  vertebra,  with  marked  rigidity  of  muscles 
and  ligaments  in  the  lower  dorsal  and  lumbar  regions. 

An  examination  of  cases  shows  a  wide  distribution  of  le- 
sion, ranging  from  the1  upper  dorsal  to  the  coccyx,  and  affecting 
ribs,  vertebrae,  spinal  muscles  and  other  tissues,  innominates, 
coccyx,  etc.  The  most  important  lesions  in  these  cases  appear 
in  the  region  of  the  lower  two  or  three  dorsal,  and  in  the  lumbar 
region.  It  is  in  this  portion  of  the  spine  that  origin  is  given  to 
the  sympathetic  nerves  supplying  the  bowel.  Particular  atten- 
tion should  be  given  the  llth  and  12th  dorsal  and  the  1st  and 
2nd  lumbar,  as  the  sympathetic  branches  from  these  points  sup- 
ply the  inferior  mesenteric  ganglion  and  the  rectum  with  motor 
fibers,  and  the  abdominal  vessels  with  constrictor  fibers.  Sym- 
pathetic distribution  for  the  small  intestine  is  from  just  above 
the  first  lumbar;  for  the  large  intestine  from  the  1st  to  4th  him- 


PRACTICE  OF  OSTEOPATHY.  147 

bar.  Hence  the  importance  of  the  lower  dorsal  and  lumbar  les- 
ion in  constipation,  as  it  may  interfere  with  the  functions  of 
motion,  secretion  and  circulation  by  obstructing  the  spinal  con- 
nections of  these  important  sympathetics. 

Lesions  of  the  lower  two  ribs  are  important  causes  of  con- 
stipation, not  only  by  spinal  interference  with  the  sympathetics 
mentioned,  but  by  direct  mechanical  pressure  upon  the  bowel, 
sometimes.  In  yet  another  important  manner  they  may  cause 
bowel  trouble  by  lesion  to  the  diaphragm  as  already  mentioned. 
The  whole  subject  of  change  in  the  diaphragm  is  an  important 
one  in  relation  to  bowel  disease.  It  is  reasonable  to  consider  that 
certain  spinal  and  rib  lesions  affect  the  diaphragm.  They  may 
cause  it  as  a  whole  to  weaken  and  sag,  may  cause  contracture  of 
the  whole  muscular  structure,  or  may  contracture  or  strain  cer- 
tain portions  of  it.  Thus  impingement  is  brought  upon  the  im- 
portant structures  passing  through  the  diaphragm,  and  having 
much  to  do  with  abdominal  activities.  The  aorta,  ascending 
cava,  thoracic  duct,  pneumogastric,  phrenics,  and  splanchnics 
may  be  interfered  with.  Or  the  sagging  of  the  diaphragm  may 
set  up  ptosis  of  the  abdominal  oigans,  thus  causing  constipation 
mechanically  or  otherwise.  This  subject  has  been  discussed  at 
length  elsewhere. 

Lesion  to  the  fourth  sacral  nerve  may  cause  contracture 
of  the  external  sphincter,  which  it  innervates.  Lesion  to  the 
lower  dorsal  and  the  lumbar  nerves  may  lead  to  loss  of  energy  of 
the  muscles  of  the  abdominal  walls,  as  may  other  causes,  and  lead 
to  constipation.  Robinson  states  that  such  a  condition  favors 
constipation  by  allowing  congestion  of  blood  and  secretions,  and 
by  lessening  intra-abdominal  pressure.  Lesions  to  the  liver  and 
pancreas,  usually  from  the  8th  to  12th  dorsal,  or  through  the 
splanchnics  or  solar  plexus,  aid  constipation  by  lessening  the 
secretions  of  these  organs,  necessary  to  stimulation  of  peristalsis. 
McConnell  states  that  contractured  muscles  are  generally  found 
in  constipation  on  the  right  side  of  the  spine  over  the  region  of 
the  liver.  Dr.  Still  makes  lesion  of  the  5th  dorsal  important  in 
tlu'se  cases. 

The  coccyx  may  be  so  misplaced  as  to  act  as  a  mechani- 
cal obstruction  to  the  passage  of  the  stool.  Lesion  at  this  point 
mav  cause  contracture  of  the  sacral  tissues  and  interfere  with 


148  PRACTICE   OF    OSTEOPATHY. 

the  fourth  sacral,  or  it  may  interfere  in  a  similar  manner  with 
the  sympathetic  distribution  to  the  rectum,  and  cause  atony  or 
contracture  of  its  walls.  A  prolapsed  uterus,  hernia,  adhesions, 
or  the  presence  of  foreign  bodies,  fruit-stones,  etc.,  may  mechanic- 
ally obstruct  the  bowel. 

Various  lesions,  as  of  the  diaphragm,  the  weight  of  a  loaded 
colon,  of  the  spinal  regions,  etc.,  producing  ptosis  of  the  abdominal 
organs,  or  of  the  colon  itself,  cause  a  kinking  of  the  flexures  by 
their  dragging  upon  their  ligaments  at  those  points.  The  same 
causes  allow  of  a  sinking  of  the  caecum  and  sigmoid  into  their 
respective  iliac  fossae,  allowing  also  the  sigmoid  to  fold  upon  it- 
self. In  these  ways  obstruction  to  the  passage  of  fecal  matter 
along  the  bowel  is  caused.  In  enteroptosis  the  pressure  of  or- 
gans upon  each  other  limits  motion,  peristalsis,  and  circulation. 
The  elongated  omenta  and  ligaments,  in  which  the  blood-vessels 
and  nerves  run  to  the  bowels,  stretch  these  structures  and  abridge 
their  function.  These  become  important  causes  of  constipation. 

The  anatomical  relations  have  been  described  in  detail  in 
considering  diarrhoea,  q.  v. 

Various  lesions,  'acting  to  weaken  circulation  and  nutrition, 
lead  to  atony  of  the  bowel  muscles,  and  to  constipation.  Any 
lessening  of  circulation  acts  to  cause  it,  as  the  circulation  of  the 
blood  about  the  nerve  terminals  in  the  bowel  wall  is  necessary 
to  their  activity. 

The  PROGNOSIS  is  good.  Most  cases  are  cured  in  a  reason- 
able length  of  time.  The  ordinary  acute  form,  occasional  con- 
stipation, is  cured  in  one  or  a  few  treatments.  Very  quick  re- 
sults are  often  obtained.  Cases  which  have  been  most  obstinate, 
and  those  that  have  been  from  birth,  have  been  readily  cured. 
Many  cases  are  obstinate  under  treatment,  and  require  time  and 
patience  to  effect  a  cure. 

The  TREATMENT  for  constipation,  from  the  nature  of  the 
case,  must  look  to  the  correction  of  the  lesion  that  is  obstruct- 
ing circulation,  peristalsis,  or  secretion  in  the  bowel,  or  to  the 
removal  of  the  mechanical  stoppage  that  sometimes  causes  the 
disease.  Some  one  or  more  of  the  special  lesions  described  are 
found,  and  may  be  removed  by  the  appropriate  methods.  The 
main  treatment  is  for  nerve-supply,  as  practically  all  of  the  le- 


PRACTICE    OP   OSTEOPATHY.  149 

sions,  except  mechanical  causes,  act  in  one  way  or  another  through 
the  innervation.  The  main  treatment  upon  the  spine  is  in  the 
lower  dorsal  and  lumbar  regions,  the  seat  of  the  chief  lesions. 
The  removal  of  the  .lesion  is  often  all  the  treatment  necessary, 
but  various  points  must  be  considered.  The  treatment  must, 
by  the  removal  of  lesion  or  otherwise,  tone  the  splanchnics,  spinal 
sympathetics,  and  solar  plexus,  as  well  as  Auerbach  and  Meissner's 
plexuses,  controlling  the  motor,  secretory,  and  other  functions 
of  the  bowels.  Special  attention  must  be  given  to  lesion  at  the 
points  mentioned  as  liable  to  them  in  this  trouble. 

Abdominal  treatment  should  be  a  deep,  slow,  relaxing  treat- 
ment carried  along  the  course  of  the  bowel.  A  very  successful 
treatment  is  to  spread  both  hands  upon  the  abdomen,  and  wrork 
deeply,  first  with  the  fingers  pressing  upon  the  ascending  colon, 
then  with  the  thumbs  upon  the  descending  colon,  thus  alternating 
the  pressure  from  side  to  side  of  the  abdomen.  This  treatment 
should  begin  lov/  in  the  iliac  fossae,  and  ascend  gradually.  It 
relaxes  all  the  tissues,  and  frees  local  circulation,  affecting  also 
the  local  nerve  distribution.  It  dwells  particularly  upon  those 
portions  in  which  are  felt  the  aggregations  of  fecal  matter,  re- 
leasing the  tissues  about  themy  softening  and  passing  them  along. 
This  is  the  special  method  of  removing  obstruction  by  foreign 
bodies,  such  as  fruit-stones,  etc.  This  treatment  should  be  given 
especially  to  the  csecal  and  sigmoid  portions,  as  they  are  generally 
full.  Attention  must  be  given  to  raising  and  straightening  them 
when  necessary.  This  may  be  done  in  the  treatments  described 
in  III  and  IV,  Chap.  VIII.  Likewise  the  colon  as  a  whole  should 
be  raised  and  straightened  to  relieve  kinking  at  its  flexures  and 
the  evil  results  to  nerves  and  blood-vessels  accruing  from  the 
stretching  of  its  omenta  in  ptosis.  The  patient  should  be  placed 
in  the  Sims  position,  or,  better,  in  the  knee-chest  position,  and 
the  bowels  should  be  thoroughly  pulled  up  out  of  the  pelvis. 
Spinal  work  and  the  correction  of  lesion  tones  these  omenta  to 
hold  in  position  the  replaced  organs. 

The  liver  should  be  thoroughly  treated  to  stimulate  the 
flow  of  bile.  By  the  removal  of  lesion,  by  treatment  to  its  spinal 
connections  through  the  splanchnics,  and  by  raising  the  8th  to 
12th  right  ribs,  this  is  in  part  accomplished.  It  is  treated  at  the 


150  PRACTICE    OF   OSTEOPATHY. 

abdomen,  as  are  the  gall-bladder  and  bile-duct.  (V,  IX,  Chap.  VIII.) 

The  inferior  mesenteric  ganglion  is  the  center  for  the  fecal 
reservoir,  and  should  be  treated  at  the  location  already  described. 
The  vagi  may  be  treated  in  the  neck  to  aid  in  the  general  process. 
The  coccyx  should  be  straightened  as  the  case  requires.  (XX, 
Chap.  II.)  A  contractured  sphincter  should  be  dilated.  (Chap. 
IX,  D.)  Or  it  may  be  released  by  strong  inhibition  over  the 
fourth  sacral  nerves.  They  may  be  located  at  the  fourth  sacral 
formania,  just  to  the  side  of  and  below  the  bony  prominences 
that  mark  the  termination  of  the  sacral  canal,  and  which  may  be 
easily  felt  beneath  the  skin. 

Peritoneal  adhesions  may  be  broken  up  gradually  by  deep 
and  careful  work  upon  the  bowel  at  their  site.  In  the  absence 
of  pain,  or  as  it  disappears,  the  treatment  may  be  made  strong, 
care  being  taken  not  to  set  up  inflammation. 

Obstruction  from  volvulus  may  be  sometimes  overcome  by 
manipulation  at  the  seat  of  the  obstruction  directed  to  the  straight- 
ening the  bowel.  This  requires  long  treatment  at  a  time,  and 
much  care  and  patience. 

Symptomatic  cases  must  be  treated  in  conjunction  with 
the  primary  disease. 

The  use  of  cold  and  hot  drinks  before  breakfast,  rectal  in- 
jections, cereal  foods,  fruits,  regularity  in  habit,  and  exercise 
are  all  helpful.  The  water  should  be  drunk  neither  too  soon  nor 
too  long  before  breakfast.  About  fifteen  to  twenty  minutes 
generally  gives  the  best'  results. 

CATARRHAL  ENTERITIS;  DIARRHOEA. 

DEFINITION:  An  acute  inflammation  of  the. intestinal  mu- 
cous membrane  due  to  specific  spinal  lesions.  Diarrhoea  is  often 
symptomatic  of  other  diseases. 

CASES:  Lesions  were  found  as  follows:  (1)  Tension  of 
the  spinal  tissues  from  the  3rd  to  llth  dorsal,  (2)  Lateral  lesion 
of  the  7th,  8th  and  9th  dorsal  vertebrae,  (3)  9th  to  llth  right 
ribs  depressed,  (4)  Right  llth  rib  down  onto  the  12th;  4th  and 
5th  lumbar  anterior;  spine  weak,  (5)  6th  to  llth  dorsal  vertebrse 
lateral  to  the  left;  12th  dorsal,  1st  and  2nd  lumbar  posterior;  ex- 
treme weakness  and  irritability  of  the  muscles  along  the  affected 
area,  especially  opposite  the  2nd  lumbar:  ribs  over  the  liver 


PRACTICE   OF   OSTEOPATHY.  151 

down,  (6)  5th  lumbar  anterior;  6th  and  7th  dorsal  posterior; 
luxation  of  lower  four  right  ribs. 

Lesions  may  occur  anywhere  along  the  splanchnic  area  and 
along  the  spine  as  low  as  the  coccyx.  The  most  important-  lesions 
effect  the  region  of  the  lower  two  dorsal  and  the  lumbar  verte- 
brae. According  to  Dr.  Still,  in  all  cases  of  diarrhoea,  and  dysen- 
tery there  is  lesion  of  the  5th  lumbar,  which,  through  the  con- 
nected sympathetic  innervation,  paralyzes  the  lymphatics  of  the 
bowels,  causing  the  exudations  and  the  stools.  The  llth  and 
12th  ribs  on  each  side  are  sometimes  found  luxated,  most  often 
downwards.  Lesion  may  occur  at  the  2d  lumbar,  the  5th  lum- 
bar, to  the  innervation  of  the  small  intestine  above  the  first 
lumbar,  to  the  innervation  of  the  large  intestine  from  the  1st  to 
4th  lumbar,  to  the  coccyx,  or  to  the  innominates.  Lesions  from 
the  8th  to  12th  dorsal  and  ribs  may  affect  liver  and  pancreas  to 
aid  the  diseased  condition. 

ANATOMICAL  RELATIONS:  In  intestinal  diseases  as  in 
stomach  diseases,  the  importance  of  the  splanchnics  and  solar 
plexus  must  be  borne  in  mind.  The  former  contain  vaso  and 
viscero-motors  to  the  intestines,  these  vaso-motors  being,  ac- 
cording to  Flint,  among  the  most  important  in  the  body,  in- 
nervating the  immense  area  of  abdominal  vessels,  which,  when 
fully  dilated,  are  said  to  be  able  to  accommodate  one-third  of 
the  total  quantity  of  blood  in  the  body.  They  contribute  to  the 
solar  plexus,  which  rules  sensation,  motion,  secretion,  nutrition, 
and  circulation  in  all  these  viscera.  Our  correction  of  circula- 
tion in  these  cases  is  an  important  consideration.  Robinson 
shows  that  movements  of  the  intestines  are  largely  dependent 
upon  the.  amount  of  blood  circulating  in  the  intestinal  walls. 
For  these  reasons  lesions  anywhere  along  the  splanchnic  region 
may  produce  important  disturbances  of  intestinal  secretions, 
circulation,  or  motion,  all  of  which  may  be  disturbed  in  diarrhoea. 

The  whole  abdominal  sympathetic  is  important  in  these 
diseases.  Stimulation  of  it  lessens  peristalsis;  stimulation  of 
the  pneumogastric  increases  peristalsis.  We  work  not  to  di- 
rectly stimulate  or  inhibit  either  of  these  for  the  purpose  of  con- 
trolling peristalsis,  but  to  remove  lesion  from  them  as  it  pro- 
duces through  them  abnormalities  of  motion. 


152  PRACTICE    OF   OSTEOPATHY. 

Auerbach  and  Meissner's  plexus  of  nerves  have  to  carry 
on  gastro-intestinal  secretion.  Auerbach 's  is  a  motor  plexus. 
They  lie  in  the  intestinal  walls,  and  may  be  directly  influenced 
by  work  upon  the  abdomen,  but  are  corrected  by  us  through 
the  removal  of  lesions  affecting  them  through  their  sympathetic 
and  spinal  connections.  Lesions  to  them,  disturbing  both  se- 
cretion and  motion,  are  important  causes  of  diarrho?a.  Robin- 
son states  that  the  inferior  mesenteric  artery,  located,  externally, 
a  little  below  and  to  the  left  of  the  umbilicus,  innervates  the 
muscular  walls  of  the  fecal  reservoir,  i.  e.,  the  left  half  of  the 
transverse  colon,  the  descending  colon,  and  the  sigmoid.  Spinal 
lesion  to  it,  through  its  connected  nerves,  is  active  in  production 
of  diarrhoea. 

The  fact  that  afferent  sympathetic  fibers  pass  from  the 
abdominal  viscera  to  the  thoracic  sympathetic  cord  may  ex- 
plain the  occurrence  of  secondary  lesions  in  the  form  of  con- 
tractured  muscles  along  the  thoracic  spine.  The  presumption 
is  that  they  are  sensory  in  function,  and  if  so,  sensory  fibers  for 
the  abdominal  viscera  may  be  associated  with  them.  Quain 
states  that  among  the  medullated  fibers  passing  into  the  sym- 
pathetic system,  some  derived  from  spinal  nerves  are  sensory 
fibers.  This  may  be  the  explanation  why  inhibition  of  the 
splanchnic  area  will  stop  pain  in  the  stomach  or  intestines. 

All  these  various  facts  indicate  the  importance  in  diar- 
rhoea of  spinal  or  lower  rib  lesion,  from  the  6th  dorsal  to  the 
coccyx,  which  may  interfere  with  the  spinal  connections  of  all 
these  abdominal  sympathetics  and  derange  their  functions. 

Our  most  important  treatment  is  given  from  the  10th  dor- 
sal down,  in  these  cases.  Lesions  in  this  lower  spinal  region  are 
of  prime  importance  in  causing  diarrhoea.  The  importance  of 
the  lesion  to  llth  and  12th  ribs  and  vertebrae,  and  to  the  upper 
two  lumbar,  is  found  in  the  fact  that  nerve  branches  from  the 
lower  dorsal  and  upper  two  lumbar  pass  to  the  inferior  mesen- 
teric ganglion,  shown  above  to  innervate  the  fecal  reservoir. 
These  branches  are  motor  fibres  for  the  circular,  and  inhibitory 
fibers  for  the  longitudinal,  muscle  fibers  of  the  rectum.  At  the 
same  time  these  lower  dorsal  and  upper  two  lumbar  nerves  send 
branches  to  the  sympathetics  and  supply  vasoconstrictor  fibres 


PRACTICE    OF    OSTEOPATHY.  153 

to  the  abdominal  vessels.  The  motor  fibers  to  the  longitudinal, 
and  inhibitory  fibres  to  the  circular,  muscle  fibres  of  the  rectum 
are  sent  from  the  sacral  nerves.  This  explains  why  the  lesion  of 
the  innominate  or  coccyx  may  cause  a  part  of  the  trouble  in  diar- 
rhoea, also  why  strong  stimulation  to  the  sacral  nerves  relieves 
tenesmus. 

Branches  from  the  four  lumbar  ganglia  go  to  the  plexus 
upon  the  aorta,  and  to  the  hypogastric  plexus.  Lesion  in  the 
lumbar  region  may  in  this  way  further  interfere  with  the  bowel. 

The  various  forms  of  enteritis  and  diarrhoea  seem  to  have 
as  their  basis  derangement  of  nerve  or  blood-supply  in  the  form 
of  inflammation  (catarrh);  lack  of  proper  vaso-innervation, 
leading  to  congestion  and  exudation;  improper  preparation  of 
digestive  fluids,  due  to  deranged  glandular  activity;  or  increased 
secretion  and  exudation. 

The  removal  of  lesion  obstructing  nerve  and  blood-supply 
corrects  these  manifestations  of  such  derangement. 

The  PROGNOSIS  is  good.  Most  cases  of  diarrhoea  are  checked 
at  once  by  a  single  treatment,  many  needing  no  further  treat- 
ment. Cases  of  years  standing  have  been  in  many  instances 
cured  in  a  short  time.  The  ordinary  acute  diarrhoea  needs  but 
one  or  a  few  treatments.  Acute  enteritis  needs  careful  treat- 
ment for  several  days  while  the  acute  process  lasts.  Even  long 
standing  cases  that  had  their  origin  in  army  dysentery  have 
been  cured. 

TREATMENT  for  diarrhoea  consists  in  the  removal  of  lesion 
as  found,  affecting  any  of  the  special  points  named  above  as 
subject  to  lesion  in  this  disease.  The  main  treatment  aside 
from  this  is  very  simple,  and  is  often  given  as  the  sole  measure 
of  relief.  It  consists  of  very  strong  inhibition  of  the  spine  from 
the  lower  dorsal  to  the  sacrum.  It  may  be  given  with  the  pa- 
tient on  his  side,  as  described  in  III,  Chap.  II.  The  "breaking 
up"  spinal  treatment  may  be  used  for  the  same  purpose.  (XXII, 
Chap.  II.)  The  former  seems  preferable.  It  may  be  applied 
to  either  side  or  to  both  sides  of  the  spine. 

Inhibition  may  be  made  at  the  llth  and  12th  dorsal  region 
by  setting  the  patient  upon  a  stool,  pressing  the  knee  against  the 
spine,  first  on  one  side  then  upon  the  other,  and  grasping  the 


154  PRACTICE    OF    OSTEOPATHY. 

arms  of  the  patient,  raising  them  above  his  head,  and  bending 
the  body  backwards  against  the  knee.  This  not  only  inhibits 
these  nerves,  but  stretches  all  the  anterior  spinal  parts  and  re- 
lated tissues  in  the  lower  dorsal  and  upper  lumbar  regions.  This 
result  is  more  important  than  the  mere  inhibition.  The  llth 
and  12th  ribs  are  often  displaced  downward,  and  may  then  drag 
portions  of  the  diaphragm  in  such  a  manner  as  to  prevent  free 
circulation  of  blood  and  lymph  in  the  vessels  perforting  it.  This 
result  alone  might  cause  diarrho?a. 

Muscular  contractions  along  the  spine  should  be  removed. 
Deep  but  careful  manipulation  should  be  made  upon  the  abdo- 
men over  the  intestines  for  the  purpose  of  relaxing  all  their  tis- 
sues, freeing  circulation  and  correcting  the  activities  of  the 
Auerbach  and  Meissner's  plexuses.  One  may  treat  to  tone  the 
solar  plexus,  splanchnics,  and  general  abdominal  circulation. 
The  liver  should  be  thoroughly  treated,  lesion  to  it  be  removed , 
and  the  secretion  of  bile  corrected.  Its  presence  in  abnormal 
quantities  may  cause  diarrhoea  through  increasing  peristalis. 
In  other  cases  its  presence  in  the  bowel  does  not  hinder  the  case, 

and  it  is  said  to  allav  irritation  of  the  mucosa.     Lesion  of  the 
\ 

8th  to  12th  dorsal  and  ribs  may  derange  either  liver  or  pancreas. 
In  fatty  diarrhoea  the  latter  must  be  looked  to. 

For  tormina  or  griping,  inhibition  of  the  splanchnics  is 
done.  For  tenesmus,  or  bearing  down  pains  in  the  bowel,  strong 
stimulation  of  the  sacral  nerves  is  made  by  thorough  manipula- 
tion of  the  tissues  over  the  sacrum. 

It  is  said  that  in  such  cases  the  abdominal  facia  is  contracted 
and  causes  congestion  mechanically.  (Chas.  Still.)  When  con- 
tracted it  should  be  relaxed  by  abdominal  manipulation. 

The  vomiting  and  purging  should  not  be  checked  if  they 
are  the  evident  means  of  getting  rid  of  the  irritating  contents 
of  the  bowel  and  stomach.  The  ordinary  case  is  seen  after 
plenty  of  opportunity  has  been  afforded  Nature  to  remove  the 
irritant  by  these  means,  and  calls  for  immediate  checking. 

In  acute  enteritis  the  case  must  be  seen  several  times  daily. 
Gentle  relaxing  treatment  should  be  made  over  the  abdomen. 
The  liver  is  to  be  lightly  treated;  spinal  muscles  relaxed:  the 
spine  gently  sprung  to  release  tension  in  its  tissues.  The  lower 


PRACTICE    OF   OSTEOPATHY.  155 

ribs  may  be  raised  a  little  and  the  neck  treated  for  relief  of  the 
head.  Careful  attention  must  be  given  to  the  diet  of  the  pa- 
tient. It  should  be  light  and  restricted.  Meat  broths,  mucilag- 
inous drinks,  etc.,  may  be  given  according  to  prescribed  dietaries. 
Warm  baths  and  rectal  injections  may  be  employed. 

Cases  of  acute  diarrhoea  and  enteritis  should  remain  'quietly 
in  bed.  The  various  measures  described  may  be  employed  as 
necessary.  Spinal  inhibition  alone  may  be  sufficient.  When 
diarrhoea  is  symptomatic  of  other  disease  it  may  be  relieved  by 
these  treatments.  Its  cure  depends  upon  the  cure  of  the  dis- 
ease present. 

The  various  diarrhoeas  of  children;  summer  diarrhoea,  gas- 
tro-enteritis,  cholera  infantum,  etc.,  are  all  treated  along  the 
same  lines,  with  special  attention  to  conditions  present.  There 
is  quite  commonly  an  acute  dyspeptic  condition  present.  Hy- 
gienic and  dietetic  measures  must  supplement  the  osteopathic 
treatment.  Fresh  air  and  cleanliness  are  essential.  Cool  bathing 
is  recommended.  Cracked  ice  may  be  given  to  allay  the  thirst, 
or  small  quantities  of  water  at  a  time.  Thin  broths,  egg-albu- 
men, etc.,  may  be  fed  to  the  child. 

These  cases  are  frequently  serious,  but  the  success  of  osteo- 
pathic treatment  has  been  very  marked. 

Croupous  or  diphtheritic  enteritis  calls  for  no  special  dis- 
cussion. It  should  be  treated  as  indicated  for  catarrhal  enteritis,, 
with  special  attention  to  the  particular  causes. 

INTESTINAL  ULCERS. 

The  various  forms  of  intestinal  ulcers  are  successfully  treated 
osteopathically.  They  are  generally  due  to  other  intestinal 
disease,  and  are  assignable  to  those  lesions  so  common  as  the 
causes  of  derangement  of  intestinal  function.  These  .general 
lesions  have  been  described  under  "constipation,"  and  "catarrhal 
enteritis." 

DUODENAL  ULCER. 

DEFINITION:  This  is  a  small,  round,  perforating  ulcer 
which  attacks  the  walls  of  the  duodenum.  It  is  the  homologue 
of  the  gastric  ulcer,  q.  v.,  and  probably  originates  in  the  same 


156  PRACTICE    OF    OSTEOPATHY. 

way.  Such  lesions  as  interfere  with  intestinal  circulation  and 
secretions  are  the  causes.  An  obstructed  area  of  circulation  in 
the  tissues  becomes  devitalized  as  a  consequence  of  the  spinal 
lesion  interfering  with  the  nerves  controlling  blood-flow.  These 
devitalized  tissues  are  acted  upon  by  the  acid  gastric  juices, 
and  the  beginning  of  the  ulcer  is  made.  These  ulcers  are  asso- 
ciated with  such  conditions  as  cause  gall-stones  and  B  right's 
disease,  and  are  referable  to  the  same  lesions. 

The  TREATMENT  is  practically  the  same  as  that  for  gastric 
ulcer  before  described.  Lesion  must  be  removed  and  circula- 
tion be  kept  free  to  correct  secretions  and  functions  of  the  in- 
testine, and  to  heal  the  ulcer.  Continued  thorough  treatment 
should  be  directed  to  the  seat  of  the  ulcer  to  keep  the  tissues  soft 
and  prevent  the  occurrence  of  cicatricial  contraction,  which  may 
result  in  obstruction. 

INTESTINAL  HEMORRHAGE  (ENTERORRHAGIA). 

Hemorrhage  is  one  of  the  most  constant  symptoms  of  du- 
odenal ulcer,  and  may  occur  in  other  forms  of  intestinal  ulcer, 
as  well  as  from  other  causes.  The  treatment  of  it  must  be  upon 
the  same  plan  as  described  for  peptic  ulcer,  q.  v.,  for  pulmonary 
hemorrhage,  q.  v.,  and  for  hemorrhage  in  typhoid  fever,  q.  v. 

Absolute  rest  must  be  enjoyed,  and  no  food  must  be  allowed, 
with  but  a  little  ice  to  suck  for  thirst.  Ice-bags  should  be  ap- 
plied to  the  abdomen,  and  the  foot  of  the  bed  should  be  elevated 
about  six  inches.  If  the  bleeding  comes  from  low  down,  small 
injections  of  ice-water  are  good.  All  active  handling  of  the  pa- 
tient must  be  avoided,  but  a  little  quiet  inhibition  may  be  made 
along  the  spine  to  quiet  heart  and  peristalsis. 

FOLLICULAR  ULCERS. 

These  are  due  to  necrosis  of  the  apices  of  the  solitary  glands 
in  enteritis.  They  have  the  same  etiology  and  pathology  as  has 
catarrhal  enteritis.  The  lesions  and  treatment  described  for 
that  disease  apply  exactly  to  this  condition. 

STERCOREAL  ULCERS'. 

These  ulcers  are  due  to  mechanical  irritation  of  hard  fecal 
«5cybala  or  enteroliths,  and  are  referable  to  such  lesions  as  cause 


PRACTICE    OF    OSTEOPATHY.  157 

constipation.  Their  treatment  is  a  most  thorough  one  for  bowel 
evacuation,  as  in  constipation.  Rectal  injections  may  be  used 
to  soften  fecal  accumulations.  The  course  of  treatment  removes 
lesion  arid  builds  up  the  circulation,  which  cures  the  ulcer.  The 
diarrhoea,  tenesmus,  and  colicky  pains  are  treated  as  before  di- 
rected. 

SIMPLE  ULCERATIVE  COLITIS. 

This  condition  is  usually  the  result  of  chronic  intestinal 
catarrh,  and  is  due  to  such  lesions  and  conditions  as  produce  it. 
The  ulceration  may  involve  considerable  areas  of  the  mucous 
lining  of  the  bowel,  showing  an  extensive  disturbance  of  the 
intestinal  circulation.  The  treatment  must  be  thorough  and 
continued  long  enough  to  overcome  the  marked  tendency  of  the 
condition  to  become  chronic.  The  diarrhoea,  in  the  stools  of 
which  pus  and  blood  are  constant,  must  be  treated  as  before. 
Constipation  may  alternate  with  it.  Constitutional  treatment 
must  be  given,  as  the  disease  is  a  drain  upon  the  system,  and  the 
patient  may  become  weak  and  emaciated.  One  must  exercise 
much  care  with  these  cases,  especially  in  the  aged.  The  diet 
should  be  fluid  or  semi-solid. 

NEUROSES  OF  THE  INTESTINE. 

The  various  lesions  producing  derangement  of  the  intestinal 
innervation,  sensory,  circulatory,  motor,  secretory  and  trophic, 
have  been  described.  Their  anatomical  relations  to  intestinal 
diseases  have  been  fully  discussed.  Various  of  these  lesions  may 
occur  and  produce  intestinal  derangements  by  special  interfer- 
ence with  certain  functional  activities  of  the  intestines,  through 
acting  as  lesions  to  the  particular  portion  of  the  innervation  hav- 
ing those  functions  in  charge.  Thus  the  lesion  may  so  act  upon 
the  sensory  innervation  as  to  cause  sensory  disease.  Or  the  pre- 
dominating disorder  may  affect  particularly  the  secretory  or  the 
motor  functions.  Sensory,  secretory,  and  motor  neuroses  of 
the  intestine  are  common.  The  lesions  producing  them  are  not 
different  in  natuie  from  the  ordinary  lesions  found  as  the  causes 
of  gastro-intestinal  disorders.  For  some  reason,  not  well  under- 
stood, certain  of  these  lesions  may  produce,  in  a  given  case,  cer- 


158  PRACTICE    OF   OSTEOPATHY. 

tain  special  kinds  of  disturbance  of  function.  In  the  diseases  de- 
scribed below  no  special  lesion  has  been  yet  described  as  the 
special  cause  of  each  condition.  One  finds  lesions  already  de- 
scribed producing  them.  As  a  rule,  however,  these  special 
sensory,  secretory,  or  motor  neuroses  are  noted  in  cases  of  bad 
intestinal  health,  and  frequently  seem  to  be  specialized  path- 
ological manifestations  of  this  general  bad  condition.  The  sen- 
sory, secretory,  or  motor  disturbance  has  gained  the  upper  hand. 
In  some  cases  the  neuroses  is  itself  the  sole  manifestation  of  the 
results  of  the  lesion. 

SECRETORY  NEUROSES. 

Membranous  Enteritis,  3Iueous  Enteritis,  or  Mucous  Colitis, 

is  often  met,  frequently  occurring  in  subjects  of  intestinal  dis- 
ease. The  special  lesions  present  and  disturbing  bowel  innerva- 
tion  act  particularly  upon  the  secretory  fibers.  The  result  is 
over-action  in  the  mucous  secreting  Igarids.  The  mucous  mem- 
brane is  not  pathologically  altered,  and  catarrh  if  present  at  all. 
is  a  secondary  effect.  It  is  a  purely  nervous  manifestation. 
Special  lesion  is  commonly  found  to  be  the  active  cause  of  irrita- 
tion to  the  centers  or  fibers  controlling  this  function.  Its  re- 
sults are  apparent  in  the  copious  secretion  of  the  intestinal  mu- 
cous, which  passes  away  from  the  patient  in  conglomerate  masses 
forming  the  whole  or  a  separate  part  of  the  stool,  in  long  ribbon- 
like  strips,  or  in  a  complete  cast  of  the  intestinal  canal  of  some 
inches  in  length. 

It  is  not  a  serious  condition,  and  removal  of  lesion,  with 
thorough  spinal  and  abdominal  treatment,  will  at  once  begin 
to  correct  the  over-action  of  the  glands.  Its  cure  may  depend 
upon  the  restoratipn  of  a  general  healthy  bowel  condition.  Re- 
lief is  generally  obtained  at  once  from  the  treatment,  but  con- 
siderable treatment  may  be  necessary  to  eradicate  the  chronic 
condition.  Tenesmus.  when  present,  is  relieved  by  strong  sacral 
stimulation.  Colic  is  relieved  by  strong  spinal  inhibition  and 
by  the  local  inhibitive  treatment  at  the  seat  of  the  pain  in  the 
abdomen. 


PRACTICE    OF    OSTEOPATHY.  159 

SENSORY  NEUROSES. 

These  disturbances  are  due  to  irritation  to  the  sensory 
nerves  supplied  by  the  splanchnics  to  the  intestines. 

Enteralgia,  Colic,  or  Intestinal  Neuralgia,  is  met  with  in  neu- 
rotic and  anemic  subjects,  and  attacks  are  induced  by  exposure, 
gout  and  local  irritation  to  the  sensory  nerves  of  the  intestine 
by  inflammation,  enteroliths,  etc.  Excepting  mechanical  irri- 
tants, lead  poisoning  and  like  agencies,  the  actual  cause  that 
weakens  the  intestines  and  lays  them  liable  to  the  action  of  such 
exciting  causes,  is  spinal  lesion  irritating  or  weakening  the 
sensory  centers  or  fibers.  Many  cases  occur  spontaneously 
from  spinal  lesion.  This  spinal  lesion  may  act  by  causing  in- 
creased .activity  in  the  muscularis,  leading  to  the  ring-like  con- 
tractions of  the  intestine  present  in  colic.  In  many  of  these 
cases  intestinal  cramps  cause  localized  contractions  in  portions 
of  the  intestines,  which  may  be  readily  seen  or  felt  through  the 
testinal  walls.  Here  the  most  efficient  treatment  is  by  local 
manipulation  over  the  seat  of  the  contraction.  Deep  inhibitive 
treatment  here  quiets  the  nerves  and  releases  the  spasm.  Such 
local  work  must  be  supplemented  by  corrective  work  upon  the 
spine,  which  prevents  further  attacks.  Strong  spinal  inhibition 
may  be  used  to  quiet  the  pain.  Some  one  point  is  generally  found 
along  the  splanchnic  area  at  which  inhibition  is  effective.  This 
is  often  high  up  in  the  splanchnic  region,  but  varies  with  the  case, 
and  is  found  by  trial.  Special  lesion  is  to  be  removed,  and  stop- 
page of  the  pain  may  depend  upon  that. 

Diminished  Sensibility  of  the  the  intestines  is  a  common  neu- 
rosis. It  may  be  both  sensory  and  motor,  and  leads  to  dimin- 
ished peristalsis,  constipation,  and  accumulation  of  the  feces  in 
a  portion  of  the  intestine,  often  in  the  rectum.  It  is  likely  to 
occur  in  diseases  of  the  brain  and  cord  in  which  the  centers  are 
effected.  Special  spinal  lesion  is  often  the  direct  cause,  or  causes 
the  cord  disease.  Cure  of  this  condition  in  such  cases  depends 
upon  cure  of  the  primary  disease.  In  other  cases,  removal  of 
lesion  and  restoration  of  activity  to  the  local  nerve-mechanism 
overcomes  the  paresis.  Spinal  and  abdominal  treatment,  di- 
rected especially  to  the  course  of  the  intestine,  to  affect  Auer- 


160  PRACTICE   OF   OSTEOPATHY. 

bach's  plexus,  and  to  the  solar  plexus,  will  aid  a  cure.  Specific 
lesions  may  cause  a  paretic  condition  of  a  bowel  segment  and  be 
responsible  for  the  trouble.  A  general  weak  condition  of  the 
nervous  system,  on  account  of  which  nervous  shocks  and  other 
disturbances  cause  this  condition,  must  be  remedied  by  upbuild- 
ing it. 

MOTOR  NEUROSES. 

Nervous  Diarrhoea  is  a  condition  in  which  increased  con- 
tractility of  the  muscularis  of  the  bowel  is  aroused  by  purely 
nervous  causes.  It  is  an  over-action  of  the  bowel,  not  present- 
ing the  usual  aspects  of  diarrhoea.  The  stools  are  softer  than 
normal,  and  frequent,  occurring  two,  three,  four,  or  five  times  in 
twenty-four  hours.  The  subject  is  as  a  rule  neurotic,  being 
hysterical,  neurasthenic,  or  of  a  very  nervous  temperament, 
but  the  characteristic  lesions  found  in  diarrhoea,  q.  v.,  are  pres- 
ent and  so  act  upon  the  nervous  mechanism  of  the  bowel  as  to 
lessen  its  motor  stability.  Thus  its  abnormal  activity,  made 
possible  by  the  lesions,  becomes  the  special  manifestation  of  the 
nervous  condition.  There  must  be  some  sufficient  reason  why 
the  general  nervous  condition  should  be  able  to  so  center  itself 
upon  the  bowel.  The  presence  of  such  lesions  as  anatomically 
weaken  the  bowel  affords  a  reasonable  explanation  of  this  phen- 
omenon. These  lesions  usually  of  the  lower  dorsal  and  lumbar 
regions,  probably  affect,  through  its  connections  with  the  llth 
and  12th  dorsal  and  the  1st  and  2nd  lumbar  nerves,  the  inferior 
mesenteric  ganglion  ruling  motor  activity  in  the  fecal  reservoir. 

A  case  of  nervous  diarrhoea  showed  lesions  of  the  llth  and 
12th  ribs,  and  of  the  lumbar  spine.  It  readily  yielded  to  the 
usual  treatment  for  diarrhoea,  coupled  with  tonic  treatment  to 
the  general  system. 

The  treatment  commonly  employed  for  diarrhoea  is  effi- 
cient in  checking  this  form.  At  the  same  time,  thorough  general 
spinal  and  neck  treatment  must  be  given  to  strengthen  the 
nervous  system.  Spinal  causes  of  the  nervous  condition  must 
be  sought  and  overcome.  The  case  yields  rapidly  to  treatment, 
but  is  very  prone  to  setbacks  due  to  nervous  disturbance.  For 
this  reason  the  patient  must  be  kept  as  free  from  exciting  in- 


PRACTICE    OF    OSTEOPATHY.  161 

fluences  as  possible.  The  condition  is  apt  to  recur  until  the 
nervousness  has  been  lessened.  Fortunately  this  latter  condi- 
tion yields  to  treatment. 

Enterospasm  is  a  neurosis  of  the  intestine  in  which  a  spas- 
modic condition  of  portions  of  the  intestinal  walls  occurs.  It 
may  result  in  temporary  obstruction,  but  its  most  usual  man- 
ifestation is  to  cause  the  stools  to  be  passed  in  separate,  rounded 
masses,  or  in  ribbon  shape.  The  latter  is  most  frequent.  While 
often  a  nervous  pheonomenon,  special  lesion  is  necessary  to  ac- 
count for  this  peculiar  manifestation  of  nervousness.  Special 
lesion  may  affect  the  inferior  mesenteric  ganglion  through  its 
spinal  connections,  or  the  motor  fibers  of  the  circular  muscles 
of  the  rectum,  originating  from  the  lower  dorsal  and  upper  one 
or  two  lumbar  nerves,  and  passing  thence  through  the  inferior 
mesenteric  ganglion  to  the  rectum. 

CHOLERA  MORBUS;  CHOLERA  INFANTUM. 

DEFINITION:  Cholera  morbus  is  an  acute  catarrhal  inflam- 
mation of  the  stomach  and  intestines,  characterized  by  severe 
abdominal  pain,  colic,  vomiting,  purging  and  muscular  cramps. 
This  condition,  when  present  in  children  under  two  years  of  age, 
is  called  cholera  infantum. 

CASES:  (1)  A  young  man  in  intense  pain;  had  vomited 
blood  several  times,  and  continuous  severe  vomiting  and  purg- 
ing were  present,  had  a  chill;  severe  griping  in  the  epigastric 
and  umbilical  regions.  Inhibition  at  the  4th  and  5th  dorsal 
vertebrae  on  the  right  stopped  the  vomiting.  Inhibition  of  the 
splanchnics  stopped  the  purging.  Cracked  ice  was  allowed  the 
patient,  and  a  hot  enema  was  administered.  After  the  first 
treatment  no  vomiting  or  purging  occurred,  and  rapid  recovery 
followed.  In  his  previous  attacks  he  had  usually  remained  in 
bed  for  three  days,  being  incapacitated  for  a  week.  Morphine 
was  usually  necessary  to  stop  the  pain. 

LESIONS:  Such  lesions  as  described  for  enteritis,  q.  v., 
are  present  in  these  cases,  weakening  the  bowel  and  rendering 
it  susceptible  to  the  agencies  usually  described  as  the  exciting 
causes.  The  irritation  of  bad  food,  etc.,  may  affect  a  healthy 
bowel  in  this  manner,  but  there  is  often  no  such  factor  in  the 
case.  Simple  chilling  of  the  body  may  cause  the  attack,  or  slight 
indiscretion  in  diet  may  bring  it  on. 

11 


162  PRACTICE    OF    OSTEOPATHY. 

The  PROGNOSIS  is  good.  Treatment  relieves  the  case  at 
once,  stopping  the  pain,  vomiting,  cramps,  etc.  The  patient 
rapidly  recovers. 

TREATMENT:  Correction  of  lesion  protects  the  patient 
against  further  attacks.  The  severe  abdominal  pain  and  colic 
are  removed  by  strong  inhibition  of  the  spine,  especially  over  the 
splanchnic  area,  and  from  the  9th  to  the  12th  dorsal.  This 
quiets  the  sensory  nerves  of  the  viscera.  Deep  inhibitive  treat- 
ment upon  the  abdomen,  over  the  seat  of  the  pain  and  about  it, 
aids  in  relieving  it.  The  vomiting  is  checked  as  before  described, 
as  is  the  diarrhoea.  The  cramps  in  the  calves  are  relieved  by 
strong  inhibition  over  the  sacrum  and  upon  the  popliteal  nerve 
in  the  popliteal  space.  The  system  should  be  strengthened 
against  collapse  by  stimulation  of  heart  and  lungs  and  by  spinal 
and  neck  treatment  for  the  general  system. 

The  patient  should  rest,  in  bed,  and  no  food  should  be 
allowed  at  first,  but  a  little  ice  is  to  be  used  to  relieve  thirst. 
Later  a  rigorously  restricted  diet  is  enforced.  Hot  injections  are 
a  valuable  measure,  aiding  in  the  removal  of  the  irritant  ma- 
terial from  the  bowel.  A  mustard  plaster  over  the  abdomen 
relieves  pain. 

HEMORRHOIDS. 

DEFINITION:  Varicose  enlargements  of  the  inferior  hem- 
orrhoidal  veins  or  of  the  hemorrhoidal  plexus. 

(1)  Hemorrhoids  and  constipation.  Lesion  at  5th  lumbar, 
coccyx  badly  bent.  (2)  7th  to  llth  dorsal  vertebrae  posterior, 
coccyx  anterior,'  innominate  forward.  Hemorrhoids  were  ac- 
companied by  indigestion  and  jaundice.  (3)  Protruding  piles 
of  several  years  standing,  constipation,  prolapsed  rectal  walls. 
Lesion  caused  by  strain  from  heavy  lifting;  a  weakened  lumbar 
region.  Cured  in  one  month. 

(4)  Constipation  and  piles  of  many  years  standing  caused 
by  a  bent  coccyx.  Four  treatments  gave  great  relief;  case  still 
under  treatment. 

LESIONS  AND  CAUSES:  The  common  bony  lesion  present 
is  a  bent  or  dislocated  coccyx,  which  acts  as  a  local  irritant  and 
mechanical  impediment  of  the  venous  return  from  hemorrhoidal 


PRACTICE   OF   OSTEOPATHY.  163 

veins.  Luxated  coccyx,  by  local  irritation  and  interference  with 
the  fourth  sacral  nerve,  may  cause  obstinate  contracture  of  the 
external  sphincter,  leading  to  constipation  or  straining  at  stool. 
Possibly  coccygeal  and  innominate  or  sacral  lesion,  by  direct  in- 
terference or  by  dragging  of  tissues,  derange  the  sacral  nerves 
supplying  motor  fibers  to  the  longitudinal  muscle  fibers  of  the 
rectal  walls,  weakening  them.  This  result  would  probably  be 
aided  by  the  interference  of  these  same  lesions  with  the  sympa- 
thetic (sacral)  nerve-supply  to  the  circulation  through  branches 
contributed  to  the  lower  hypogastric  and  hemorrhoidal  plexuses. 
That  of  the  coccyx  seems  to  the  most  important  lesion  in  hem- 
orrhoids. 

Lumbar  and  lower  dorsal  lesion  may  be  present  and  inter- 
fering with  the  innervation  of  the  abdominal  walls,  relaxing  them, 
lessening  intra-abdominal  pressure,  and  allowing  of  conges- 
tion of  the  abdominal  circulation.  By  direct  effect  or  by  causing 
constipation,  this  condition  may  cause  hemorrhoids.  Lower 
dorsal  and  upper  lumbar  lesion  to  the  nerve  fibers  which  pass  by 
way  of  the  inferior  mesenteric  ganglion  to  supply  motor  fibers 
to  the  circular  muscles  of  the  rectal  walls  may  become  a  factor 
by  weakening  the  wall,  relaxing  its  tone,  allowing  of  a  conges- 
tion in  its  vessels.  Lesion  to  the  splanchnic  and  lumbar  areas, 
affecting  the  sympathetic  supply  which,  through  the  splanch- 
nics,  solar  plexus,  and  other  sympathetic  vaso-and  viscero- 
inotors  originating  along  these  same  areas,  rules  circulation  and 
muscular  tonus  in  the  abdominal  and  pelvic  viscera,  may  con- 
tribute in  an  important  way  to  causation  of  hemorrhoids.  Like- 
wise those  lesions  to  the  spine  and  lower  ribs,  well  known  as 
causes  of  liver  derangement,  become  causes  of  hemorrhoids 
by  producing  obstructed  portal  circulation  and  constipation. 
The  chief  drainage  by  the  hemorrhoidal  plexus  of  veins  is  through 
the  portal  circulation  by  way  of  the  superior  hemorrhoidal  vein. 
Lesions  causing  disease  of  the  heart  and  lungs,  q.  v.,  may  second- 
arily become  the  causes  of  hemorrhoids  through  the  systemic 
circulation.  Lesions  causing  atonic  diaphragm  and  other 
causes  of  enteroptosis,  q.  v.,  produce  hemorrhoids  by  the  me- 
chanical obstruction  of  circulation,  and  by  deranged  nerve- 
supply,  etc. 


164  PRACTICE    OF    OSTEOPATHY. 

The  ANATOMICAL  RELATIONS  are  pointed  out  above.  The 
American  Text-Book  of  Surgery  calls  attention  to  the  fact  that 
these  veins  are  unsupplied  with  valves  and  also  that  they  tend 
to  become  congested  by  the  natural  upright  position  of  the  body. 
These  facts  aid  in  explaining  the  potency  of  the  above  lesions, 
and  of  any  obstructive  condition  (pregnancy,  over-eating,  etc.) 
in  causing  this  condition. 

The  EXAMINATION  must  be  made  by  both  inspection  and 
palpation,  the  use  of  a  proper  speculum  aiding  a  thorough  in- 
spection of  the  rectum. 

The  PROGNOSIS  is  very  favorable.  The  usual  medical 
treatment  is  palliative,  or  surgery  is  resorted  to.  The  latter 
may  often  become  necessary,  but  the  success  of  osteopathic 
treatment  prevents  many  operations. 

Even  the  most  severe  cases  have  been  successfully  treated. 
The  treatment  generally  begins  to  succeed  immediately.  Long 
standing  cases  are  often  cured  in  a  few  months.  Some  cases 
are  slow  and  obstinate. 

The  TREATMENT  is  local,  abdominal,  spinal  and  constitu- 
tional. 

Local  treatment  is  first  directed  to  correcting  the  coccyx 
if  necessary.  (XX,  Chap.  II.)  The  external  sphincter  should 
be  well  dilated.  This  may  be  accomplished  by  inserting  two, 
or  even  three,  fingers,  well  vaselined,  and  held  together  at  the 
tips  in  wedge-shape.  After  being  well  inserted,  they  are  spread 
apart  and  withdrawn  carefully.  The  dilatation  must  be  thor- 
ough. The  rectal  speculum  may  be  used  for  this  purpose.  All 
the  surrounding  tissues,  both  externally  and  internally,  are  to  be 
thoroughly  but  gently  relaxed.  Internally  this  operation  should 
be  carried  as  far  up  along  the  rectal  walls  as  the  index  finger  is 
able  to  work.  Pressure  is  made  upon  the  injected  veins  to  empty 
them  of  blood  and  to  stimulate  their  local  nerve  and  muscle 
substance  to  proper  tonus.  In  case  of  thrombi  in  strangulated 
veins,  the  manipulation  about  and  upon  them  must  be  gently 
applied  with  the  purpose  of  stimulating  the  circulation  to  a  grad- 
ual absorption  of  them.  They  must  not  be  broken  up  or  de- 
tached, as  there  is  danger  of  their  being  swept  into  the  circula- 
tion as  emboli. 


PRACTICE    OF    OSTEOPATHY.  165 

After  dilatation  of  the  sphincter  and  relaxation  of  the  tis- 
sues, protruding  piles,  first  emptied  if  possible,  must  be  gently 
pressed  back  beyond  the  sphincter.  If  the  rectal  walls  are 
prolapsed,  as  is  often  the  case  in  protruding  piles,  they  must 
be  replaced  by  the  index  finger  directed  to  straightening  out  and 
pushing  them  up  on  all  sides. 

This  local  work  removes  irritation  of  the  coccyx,  frees  the 
whole  local  circulation,  tones  the  local  musculature  and  other 
tissues,  and  stimulates  the  local  sympathetics.  It  may  be  the 
sole  and  sufficient  treatment  in  many,  bad  cases.  It  should  be 
given  but  once  per  week  or  ten  days. 

Abdominal- treatment  is  for  the  purpose  of  increasing  free- 
dom of  circulation  and  to  aid  in  the  venous  return.  The  solar 
and  hypogastric  plexuses  are  stimulated  and  manipulation  is 
made  over  the  course  of  the  inferior  mesenteric  and  common 
and  internal  iliac  arteries.  Portal  circulation  is  helped  by  deep 
abdominal  work  from  the  lower  abdominal  region  upward  to  the 
liver.  Lesions  to  the  latter  organ  are  removed,  and  thorough 
treatment  given  to  the  liver,  as  in  the  treatment  for  constipation, 
q.  v.,  which  must  be  relieved,  it  being  usually  present.  (V.  Chap. 
VIII.) 

The  viscera  are  raised,  and  treatment  is  made  deep  in  the 
iliac  fossae  to  stimulate  the  pelvic  sympathetic  plexuses  and 
to  aid  venous  return  from  the  hemorrhoidal,  vescical,  uterine, 
and  other  related  plexuses  of  veins.  (II,  III,  IV,  Chap.  VIII). 
If  the  patient  is  placed  in  the  knee-chest  position  while  abdom- 
inal treatment  is  performed  with  the  ideas  explained  above,  the 
force  of  gravitation  is  made  to  assist  in  venous  drainage  of  the 
parts.  This  is  an  important  treatment,  and  should  not  be  omitted 
in  these  cases. 

Enteroptosis  and  diaphragmatic  lesion  are  repaired  as  be- 
fore explained. 

Thorough  spinal  treatment  is  given  from  the  sixth  dorsal 
down,  stimulating  splanchnics  and  other  sympathetics,  with 
all  their  contained  vaso  and  viscero-motor,  circulatory,  and 
trophic  fibers.  This  treatment  is  to  strengthen  circulation  and 
to  maintain  its  freedom.  It  is  supplementary  to  the  abdominal 
work.  It  also  aids  in  restoring  tone  to  the  vessel  walls,  as  well 


166  PRACTICE  OF  OSTEOPATHY. 

as  to  prolapsed  rectal  walls,  and  thus  to  maintain  them  in  cor- 
rect condition.  Anatomical  relations  between  the  spinal  work 
and  the  effect  gotten  at  the  seat  of  the  disease  have  been  ex- 
plained. 

Correction  of  spinal,  rib,  or  innominate  lesion  is  made  if 
necessary.  In  this  way,  'and  by  work  along  the  lower  dorsal 
and  upper  lumbar  regions,  coupled  with  the  local  treatment 
upon  the  abdominal  walls,  the  latter  are  built  up  and  restored 
to  normal  tonus  if  relaxed. 

The  constitutional  treatment  consists  in  the  general  spinal 
treatment,  and  in  special  treatment  for  heart  and  lung  diseases 
if  present  and  causing  the  hemorrhoids. 

Light  out-door  exercise  and  absolute  personal  cleanliness 
should  be  enjoined  upon  the  patient. 

INTESTINAL   TUMORS. 

Intestinal  Tumors  of  various,  kinds,  both  benign  and  malig- 
nant have  been  frequently  treated  osteopathically  with  success. 
Medical  treatment  is  but  palliative,  and  the  only  means  of  re- 
moval has  been  by  surgical  operation.  The  fact  that  in  numer- 
ous instances  these  tumors  have  been  entirely  removed  by 
osteopathic  treatment  is  in  itself  remarkable,  and  helps  to  sus- 
tain the  claim  often  made,  that  the  use  of  the  knife  is  often 
obviated  in  the  treatment  of  such  conditions. 

The  TREATMENT  is  simple,  and  consists  in  the  removal  of 
spinal  lesion,  which  may  be  of  any  of  the  kinds  described  as 
producing  gastro-intestinal  disease.  At  bottom  the  real  cause 
of  these  growths  is  some  obstruction  or  irritation  to  local 
blood  and  nerve-supply,  It  has  already  been  shown  how  special 
lesion  causes  this  obstruction,  or  lays  the  foundation  of  the  con- 
dition which  directly  or  indirectly  produces  the  irritation.  The 
treatment  is  therefore  the  removal  of  lesion  and  the  restoration 
of  normal  nerve  and  blood-supply.  Spinal  treatment,  aided  by 
abdominal  work,  accomplishes  this  object.  The  latter  is  done, 
not  upon  the  tumor  itself,  but  upon  the  surrounding  parts.  It 
relaxes  tensed  tissues,  opens  arterial  blood-supply  and  venous 
and  lymphatic  drainage,  and  restores  normal  condition.  In  this 
way  the  progress  of  the  morbid  process  is  stopped,  healthy  tissue 
is  built,  and  the  tumor  disappears,  by  absorption.  At  least  one 
case  is  upon  record  in  which  the  tumor,  a  fibroid,  was  loosened 


PRACTICE  OF  OSTEOPATHY.  167 

by  the  treatment  and  passed  per  rectum.  (Cosmopolitan  Osteo- 
path, Feby.,  1900,  p.  30.)  The  diet  should  be  light,  and  of  a  sort 
easily  digested.  Rectal  feeding  has  sometimes  to  be  resorted  to 
in  cases  where  the  tumor  causes  obstruction. 

Attendant  conditions,  such  as  constipation,  fecal  impac- 
tion,  colic,  etc.,  are  treated  as  described  elsewhere.  See  also 
section  upon  "Tumors." 

APPENDICITIS. 

DEFINITION:  An  inflammation  of  the  vermiform  appen- 
dix, acute  or  chronic,  caused  by  traumatism,  or  by  specific  rib 
or  spinal  lesions.  These  lesions  obstruct  bowel-action,  limit 
its  motion,  deplete  its  nerve  and  blood-supply,  leaving  a  weak- 
ened condition,  allowing  of  aggregation  of  fecal  matter,  foreign 
bodies,  etc.  The  vigor  to  pass  these  onward  is  lacking,  and  they 
are  pressed  into  the  appendix,  which  itself  is  suffering  from  a 
weakened  state  due  to  these  causes.  Or  direct  irritation  of  le- 
sion may  affect  nerve  and  blood  mechanism,  derange  vaso-mo- 
tion,  and  set  up  the  inflammation.  Or  the  direct  mechanical 
irritation  of  a  displaced  lower  rib  may  set  up  the  inflammation. 

CASES:  (1)  Lesions;  2d  lumbar  lateral,  with  heat  and  pain 
about  it;  llth  right  rib  luxated.  Treatment  relieved  at  once, 
and  the  patient  was  cured  in  two  weeks.  Surgeon  had  been 
ready  to  operate.  (2)  12th  right  rib  down  and  inside  of  the 
crest  of  the  ilium.  Setting  the  rib  cured  the  case  in  a  few  days. 
(3)  Recurring  appendicitis;  spine  posterior  in  lower  dorsal  and 
upper  lumbar;  lateral  curve  at  6th  to  9th  dorsal;  constipation 
chronic;  cured  by  ten  weeks  treatment.  (4)  Tenderness  upon 
right  side  of  spine  from  6th  dorsal  to  2d  lumbar,  especially  at 
the  6th  to  10th  dorsal  and  1st  and  2d  lumbar.  (5)  Lesion  at 
lower  dorsal  and  upper  lumbar;  10th  and  llth  ribs  overlapping 
12th,  due  to  a  fall.  Operation  had  been  advised,  but  two  months 
treatment  cured  the  case.  (6)  Appendicitis  in  a  boy  of  twelve, 
for  which  operation  had  been  advised.  Examination  showed 
downward  displacement  of  llth  and  12th  ribs,  a  posterior  con- 
dition of  the  5th  lumbar  vertebra.  Incontinence  of  urine  was 
also  a  feature  of  the  case.  The  case  was  cured  by  correction  of 
the  lesions.  (7)  A  severe  acute  case,  in  which  operation  was 


168  PRACTICE    OF    OSTEOPATHY. 

about  to  be  performed.  The  patient  was  in  great  agony  when 
the  treatment  was  begun.  Treatment  gave  immediate  relief, 
and  the  case  was  cured.  Lesion  was  found  at  the  5th  lumbar. 
(8)  A  chronic  appendicitis  of  five  months  standing,  in  a  young 
man  of  twenty-five.  Lesion  was  present  as  a  lateral  displace- 
ment of  the  9th  to  12th  dorsal  vertebrae  to  the  left.  This  same 
spinal  area  was  anterior.  The  bladder  would  not  empty.  By 
twenty-two  treatments  the  case  was  cured,  within  three  months. 
Pain  at  McBurney's  point  was  relieved  at.  the  second  treatment 
and  did  not  recur. 

LESIONS  AND  CAUSES:  (1)  There  is  usually  a  history  of 
constipation  in  these  cases.  In  some  it  follows  diarrhoea.  There 
can  be  no  doubt  that  the  lesions  causing  these  diseases,  q.  v., 
are  the  real  causes  of  appendicitis  in  many  cases.  Many  ap- 
parently robust  men  suffer  from  this  disease,  but  experience 
shows  that  many  such  have  unhealthy  bowels  to  begin  with. 
Many  show  the  specific  spinal  lesion.  The  cases  caused  by  a 
foreign  body,  seeds,  shot,  enteroliths,  etc.,  would  probably  not 
become  victims  of  appendicitis  but  for  weakened  bowel  condition 
due  to  such  lesions  as  cause  constipation.  The  fact  that  very  often 
the  body  is  a  fecal  concretion  supports  this  view.  The  inflam- 
mation is  a  vaso-motor  disturbance.  Such  disturbances,  due  to 
lesion,  have  been  seen  to  be  the  causes  of  constipation,  etc.  The 
appendix  must  suffer  with  the  rest  of  the  bowel  from  these  causes, 
and  thus  being  weakened  cannot  further  resist  special  causes  of 
vaso-motor  disturbance. 

(2)  Displacement,  or  dragging  of  the  colon  at  the  hepatic 
flexure  prevents  the  passage  of  fecal  matter  and  forces  the  intro- 
duction of  fecal  masses  into  the  appendix.     It   also  obstructs 
circulation,  causing  congestion  and  favoring  inflammation. 

(3)  The  most  important  bony  lesions  seem  to  be  displace- 
ments of  the  lower  two  ribs  on  the  right  side.     They  may  add 
mechanical  obstruction  or  irritation  to  deranged  nerve-connec- 
tions at  the  spine. 

(4)  Lesions  of  the  dorsal  and  lumbar  regions  are  very  im- 
portant on  account  of  the  nerve  connections  with  the  bowel. 
From  the  9th,  10th,  llth  and  12th  dorsal  region  sensory  nerves 
pass  through  the  sympathetics  to  supply  the  intestines  down  to 


PRACTICE    OF   OSTEOPATHY.  169 

the  upper  part  of  the  rectum.  For  this  reason  strong  inhibition 
to  this  portion  of  the  spine  is  useful  in  controlling  the  pain  in 
appendicitis.  The  sympatheic  vaso-constrictor  fibers  for  the 
abdominal  vessels  pass  from  the  lower  dorsal  and  upper  two 
lumbar  nerves,  while  branches  from  the  lumbar  ganglia  pass 
to  the  plexus  upon  the  aorta  and  to  the  hypogastric  plexus. 
Thus  lower  dorsal  and  lumbar  lesion  has  an  important  effect  in 
disturbing  the  vaso-motor  innervation.  necessary  to  the  produc- 
tion of  this  inflammation. 

(5)  Direct  traumatism  to  the  region  of  the  appendix,  the 
presence  of  foreign  bodies  in  the  bowel,  or  extended  inflamma- 
tion from  contiguous  structures,  may  all  be  causative  factors. 

The  anatomical  relations  given  for  lesion  in  diarrhoea  apply 
to  those  in  appendicitis. 

The  appendix  has  the  same  structure  as  the  caecum,  prac- 
tically; is  nourished  by  a  branch  of  the  ileo-colic  artery,  possesses 
innervation  (Auerbach  and  Meissner's  plexus?),  causing  in  it 
peristalsis  and  secretion  of  abundant  tough  mucous  from  its 
numerous  mucous  glands.  In  health  the  free  secretion  of  this 
mucous  fills  the  cavity  of  the  structure  to  the  exclusion  of  foreign 
bodies,  but  upon  lesion  to  the  blood  or  nerve-supply  such  as 
mentioned  above,  lessened  secretion  allows  of  room  for  the  en- 
trance of  foreign  bodies.  Byron  Robinson  says  that  active  oc- 
cupations in  men,  contracting  the  abdominal  walls,  favor  thus 
the  forcing  of  matter  into  the  appendix,  causing  appendicitis. 
But  it  is  very  likely  that  some  lesion,  of  the  kinds  above  described, 
first  weakens  the  tissues  of  the  appendix  and  lessens  its  normal 
condition  and  secretions,  laying  it  liable  to  such  accident. 

Anemia  may  become  a  cause  of  the  inflammation  in  it. 

The  PROGNOSIS  is  favorable  for  recovery  in  nearly  all  cases. 
The  experience  with  cases,  even  the  most  dangerous  acute  ones, 
has  been  very  satisfaot  ory.  Many  such  are  upon  record,  restored 
to  health  after  operation  had  been  advised  as  the  last  resort.  If 
seen  in  time,  very  few  cases  need  ever  come  to  the  knife.  The 
point  of  surgical  interference  is,  however,  often  reached.  Osteo- 
pathic  treatment  prevents  the  case  falling  into  the  chronic  form 
so  commonly  met,  and  in  which  operation,  to  prevent  an  acute 
attack,  is  so  often  resorted  to.  The  acute  case  is  usually  aborted 
by  prompt  treatment. 


170  PRACTICE    OF    OSTEOPATHY. 

TREATMENT:  The  first  consideration  is  the  removal  of  the 
lesion  if  possible  in  the  patient's  condition.  This  applies  par- 
ticularly to  displacements  of  the  llth  and  12th  ribs.  Here  gentle 
manipulation  and  slight  elevation  may  be  sufficient  to  remove 
the  irritation.  Immediate  attention  should  also  be  given  to  the 
relief  of  the  constipation  commonly  present.  If  not  soon  affected 
by  the  treatment,  rectal  injection  should  be  employed.  This 
measure  materially  aids  conditions  by  removing  the  pressure  of 
bowel  contents  from  tender  points,  by  giving  freedom  of  circu- 
lation in  the  bowel,  and  by  aiding  to  remove  foreign  bodies. 

An  essential  part  of  the  treatment  is  local  treatment  of  the 
tissues  at  or  above  the  site  of  the  inflammation.  By  care,  little 
difficulty  will  be  experienced  in  applying  such  treatment  even 
in  very  painful  cases.  The  relaxation  of  the  tissues  thus  ac- 
complished gives  immediate  relief  to  the  patient.  Not  only  the 
abdominal  walls,  but  the  deep  tissues  and  circulation  about  the 
appendix  are  thus  treated.  The  treatment  must  be  slow,  deep, 
inhibitive  and  given  with  great  care.  In  the  intervals  of  treat- 
ment, it  may  be  necessary  to  apply  the  ice-bag  or  hot  fomenta- 
tions at  the  seat  of  the  inflammation. 

It  is  not  likely  that  in  this  contingency  spinal  work  to  in- 
crease peristalsis  would  be  at  all  successful  in  removing  the  for- 
eign body  from  the  appendix.  Local  manipulation  must  be 
depended  upon  for  this.  The  pain  is  relieved  by  spinal  inhibi- 
tion from  the  9th  to  the  12th  dorsal  particularly.  Xausea, 
vomiting,  fever,  and  hiccough,  aside  from  being  relieved  by  the 
general  treatment  of  the  case,  may  be  relieved  by  the  usual  meth- 
ods before  described. 

The  patient  should  go  to  bed  at  once  upon  the  attack  threat- 
ening. A  restricted  fluid  diet,  taken  a  little  at  a  time,  should  be 
enforced.  Attention  should  be  given  the  kidneys  and  general 
condition.  The  patient  should  be  seen  several  times  daily  until 
out  of  danger.  Continued  treatment  should  be  given  for  a  while 
after  recovery  to  prevent  recurrence  or  relapse. 

The  chronic  case,  possessing  various  degrees  of  chronic 
pain,  tenderness  of  tissues,  and  inflammation  in  the  right  iliac 
fossa,  is  a  familiar  object.  The  purpose  of  the  work  is  to  remove 
lesion,  to  restore  perfect  freedom  of  circulation,  and  by  local 


PRACTICE    OF   OSTEOPATHY.  171 

treatment  of  the  tissues  to  remove  tenseness  and  pain.  Thor- 
ough spinal  and  abdominal  treatment,  and  attention  to  the  gen- 
eral condition  of  the  bowel  are  necessary.  The  disappearance 
of  tenderness  in  the  right  iliac  fossa  does  not  remove  the  danger 
of  acute  attack,  as  extensive  morphological  changes  have  usually 
taken  place  in  the  tissues  of  the  appendix,  which  call  for  a  course 
of  treatment  to  so  restore  circulation  as  to  enable  it  to  repair 
them. 

RECURRENT  APPENDICITIS  frequently  comes  under  treat- 
ment, and  presents  the  same  lesions  as  have  been  above  described. 
No  special  mention  need  be  made  regarding  its  treatment,  in  ad- 
dition to  what  has  been  in  regard  to  the  treatment  of  chronic 
and  acute  cases. 

INTESTINAL  OBSTRUCTION. 

DEFINITION:  The  occlusion  of  the  bowel  may  be  but  par- 
tial, persisting  as  a  chronic  condition.  In  acute  cases  it  may 
be  wholly  or  partially  obstructed.  It  may  be  due  to  strangu- 
lation; to  twists  and  knots,  called  volvulus;  to  strictures  and 
tumors;  or  to  intussusception. 

CASES:  (1)  Fecal  impaction.  Severe  radiating  abdominal 
pains,  griping,  and  some  dysentery  had  been  present  for  twenty- 
four  hours.  The  impaction  was  located  at  the  hepatic  flexure. 
Treatment  relieved  the  pain  at  once,  and  the  manipulation  re- 
moved the  obstruction.  Complete  recovery  followed. 

(2^  Volvulus  was  diagnosed,  located  near  the  ileo-csecal 
valve.  The  surgeon  was  ready  to  operate.  Persistent  treat- 
ment straightened  the  bowel  and  a  movement  of  the  bowels  was 
had.  The  recovery  was  complete. 

(3)  Impaction  of  the  ileo-caecal  valve.     The  attack   came 
on   violently   at   night.     The   family   physician,    after  'eighteen 
hours  work  over  the  patient,   advised  operation.     Osteopathic 
treatment  reduced  pain  and  inflammation  at  once,  and  allowed 
a  further  examination.     The  impaction  was  located  at  the  ileo- 
caecal  valve,  and  manipulation  removed  it  within  a  short  time. 
The  patient  was  asleep  in  thirty  minutes. 

(4)  Intestinal  obstruction  from  fecal  impaction,  in  a  boy. 
Three  physicians  had  given  the  patient  up.     The  abdomen  was 


172  PRACTICE    OF    OSTEOPATHY. 

much  swollen  and  intensely  painful,  and  the  seat  of  the  obstruc- 
tion could  not  be  located.  Tension  was  found  in  the  tissues  of 
the  spine  at  the  10th  dorsal.  Inhibitive  treatment  was  made 
here,  while  the  pneumogastric  were  stimulated.  This  treatment 
was  kept  up  throughout  the  night.  An  enema  was  given.  Early 
in  the  morning  the  bowels  were  gotten  to  move  successfully,  and 
in  a  few  weeks  the  boy  was  quite  well. 

(5)  Intestinal  obstruction  in  a  child  of  7  months  of  age. 
Physicians  gave  up  the  case,  and  were  ready  to  resort  to  sur- 
gery as  the  last  hope.     By  one  treatment  the  baby's  howels 
were  moved,  and  the  case  was  entirely  cured. 

(6)  In  a  case  of  fecal  impaction  in  the  splenic  flexure  of 
the  colon,  ten  minutes  treatment  relieved  the  intense  pain  and 
opened  the  bowels.     The  patient  had  been  about  to  undergo 
operation  for  appendicitis,  as  the  condition  had  been  wrongly 
diagnosed. 

LESIONS  AND  CAUSES:  Only  in  rare  cases  would  it  be  likely 
that  some  specific  lesion  would  lead  directly  to  this  trouble,  but 
in  most  of  them  it  is  probable  that  lesions  would  be  present  ac- 
counting for  the  bad  condition  of  the  bowel  that  resulted  in  some 
form  of  obstruction.  In  general  one  would  expect  such  lesions 
as  have  already  been  described  as  interfering  with  the  abdominal 
organs.  Intussusception  is  sometimes  due  to  irregular,  limited, 
sudden,  or  severe  peristalsis.  In  such  cases  special  lesion  to  the 
splanchnics,  or  to  the  sympathetic  connections  of  Auerbach's  plex- 
us, might  result  directly  in  the  abnormal  peristalsis  producing  the 
invagination.  In  such  cases  the  outer  layer,  or  receiving  portion 
of  the  bowel  involved,  draws  up  by  contraction  of  its  longitu- 
dinal fibers.  Such  abnormal  activity  of  these  fibers  might  also 
be  due  to  some  special  lesion  to  motor  innervation. 

In  some  cases  McConnell  suggests  that  special  spinal  lesion 
could  cause  paresis  or  paralysis  of  a  bowel  segment.  Such  a  con- 
dition could  allow  of  a  pouching  of  the  affected  portion,  and  of 
accumulation  of  feces  or  foreign  bodies.  Specific  lesion  might 
also  cause  stricture  by  contraction  of  a  segment. 

The  fact  that  obstructions  often  follow  constipation  or 
diarrhoea  shows  the  importance  of  lesions  producing  a  bad  bowel 
condition.  Volvulus  is  especially  frequent  at  the  sigmoid  and 


PRACTICE  OF  OSTEOPATHY.  173 

at  the  caecum,  enteroptosis  being  the  cause,  through  allowing 
the  parts  to  prolapse  and  turn.  Volvulus  may  be  caused  by  a 
long  or  relaxed  mesentery.  The  frequency  of  spinal  lesions 
causing  the  weakened  omental  supports  that  allow  of  the  ptosis 
shows  the  importance  of  spinal  lesion  as  a  factor  in  causing  ob- 
structions. Spinal  or  rib  lesion  may  be  looked  to  as  the  original 
cause  of  a  large  number  of  the  various  forms  of  obstruction.  It 
may  produce  the  tumor  whose  pressure  obstructs  the  bowel; 
the  peritonitis,  following  which  adhesions  cause  strangulation; 
the  ulceration  in  the  bowel  which  gives  place  to  cicatrization  and 
stricture;  or  the  inactive  condition  of  bow^el  motion  and  secre- 
tion that  allows  of  accumulation  of  fecal  matters,  foreign  bodies, 
etc.  A  healthy  bowel,  perfectly  free  from  the  effect  of  lesion  of 
any  kind,  could  only  under  rare  conditions  become  the  seat  of 
one  of  the  various  forms  of  obstruction. 

The  importance  of  lesion  producing  unhealthy  abdominal 
or  internal  conditions  must  be  acknowledged  in  the  etiology  of 
these  cases. 

The  ANATOMICAL'  RELATIONS  of  these  various  lesions  have 
already  been  pointed  out  in  the  consideration  of  various  intes- 
tinal diseases. 

The  PROGNOSIS  must  be  guarded.  Very  many  cases  die, 
and  surgical  measures  have  generally  been  considered  necessary 
after  the  third  day  of  obstruction.  Yet  osteopathic  treatment 
has  been  successful  in  a  number  of  cases  after  the  necessity  for 
operation  had  been  urjred.  Probably,  as  in  the  case  of  appendi- 
citis, many  lives  could  be  saved  by  osteopathic  means  before 
surgery  is  resorted  to. 

In  chronic  cases  the  prognosis  for  recovery  is  very  favor- 
able. Most  cases  could  be  prevented  from  coming  to  the  point 
of  absolute  obstruction.  If  they  could  be  foreseen,  most  acute 
cases  could  no  doubt  be  prevented  by  osteopathic  treatment. 

TREATMENT:  In  such  cases  as  depend  upon  a  special  le- 
sion it  should  be  removed.  Generally  the  first  consideration  is 
the  alleviation  of  the  patient's  condition.  Strong  inhibition  of 
the  splanchnic  area,  especially  from  the  9th  to  12th  dorsal,  and 
of  the  lumbar  region,  aids  in  lessening  the  pain.  This  step  may 
be  necessary  before  abdominal  manipulation  can  be  borne.  The 


174  PRACTICE    OF    OSTEOPATHY. 

solar  plexus  should  now  be  inhibited.  A  slow,  deep,  but  gentle 
inhibitive  treatment  should  next  be  given  over  the  bowel  to  re- 
lax the  tissues,  decrease  the  inflammation,  and  lessen  the  pain 
This  treatment  may  be  used  to  quiet  abnormal  peristalsis  if  pres- 
ent. After  this  preliminary  treatment  the  practitioner  may  pro- 
ceed by  careful  palpation  to  locate  the  seat  of  obstruction  if  pos- 
sible. This  is  often  impossible,  and  in  such  cases  one  must  work 
over  the  bowel  generally.  In  some  cases  the  obstruction  is  felt, 
or  the  seat  of  the  pain  is  an  indication  of  its  position. 

The  main  work  must  be  done  by  abdominal  manipulation. 
The  parts  of  the  intestine  must  be  so  managed  as  to  be  raised, 
straightened,  and  drawn  away  from  each  other.  The  caecum 
and  sigmoid  may  be  raised  and  straightened,  (Chap.  VIII,  divs. 
II,  III,  IV).  Deep  treatment  may  be  made  in  the  right  and  left 
hypochondriac  regions  to  free  the  hepatic  and  splenic  flexures. 
In  intussusception  the  parts  should  be  raised  and  drawn  from  each 
other  toward  the  extremities  of  the  cylindrical  tumor,  if  it  can 
be  made  out.  In  volvulus,  raising  and  straightening  the  involved 
portions  is  relied  upon. 

The  stricture  and'  adhesions  may  be  manipulated  with  the 
purpose  of  softening,  relaxing,  and  breaking  them  down.  For- 
eign bodies  and  fecal  aggregations  must  be  gradually  loosened 
and  worked  along  the  bowel.  They  are  more  readily  handled 
than  other  forms.  It  may  be  necessary  to  manipulate  them 
after  rectal  injection,  to  aid  in  moving  them.  Copious  injec- 
tions sometimes  aid  in  overcoming  intussusception,  volvulus, 
etc.  Injections  of  Sedlitz  powder  solutions,  injected  separately, 
have  been  successfully  used.  During  the  abdominal  treatment  it 
is  well  for  the  patient  to  be  placed  in  various  positions ;  upon  the 
back,  sides,  upon  the  abdomen,  in  the  knee-chest  position,  etc., 
to  get  the  aid  of  gravity  in  righting  the  parts.  Some  writers 
recommend  thorough  shaking  of  the  patient.  He  is  held  by  four 
men  by  the  arms  and  legs,  first  with  the  abdomen  upward,  then 
downward,  while  the  shaking  is  done. 

There  should  be  much  persistence  in  the  treatment.  The 
practitioner  should  remain  continuously  with  the  case,  and  treat 
it  as  much  as  practicable,  until  relieved.  In  the  intervals,  hot 
applications  over  the  seat  of  the  pain  may  made. 


PRACTICE    OF    OSTEOPATHY.  175 

In  chronic  cases  the  treatment  may  be  carried  on  as  usual, 
upon  the  plan  given  above  for  the  treatment  of  acute  cases. 
After  removal  of  obstruction,  a  thorough  course  of  general  treat- 
ment should  be  undertaken  for  the  removal  of  lesions  that  have 
originally  impaired  the  bowel  or  have  produced  abnormal  ab- 
dominal conditions. 

ENTEROPTOSIS. 

Enteroptosis  is  a  disease  in  which  various  of  the  abdomi- 
nal and  pelvic  viscera  leave  their  natural  positions,  slipping 
downward  into  the  abdominal  and  pelvic  cavities.  It  is  a  com- 
mon and  distressing  complaint,  frequently  overlooked  or  not 
recognized.  It  is  sometimes  regarded  as  a  symptom  group, 
but  may,  from  the  osteopathic  point  of  view,  be  regarded  as  an 
idiopathic  condition,  due  to  specific  lesion. 

These  cases  are  often  treated  for  some  one  feature,  as  for 
nervous  dyspepsia,  constipation,  operation  for  floating  kidney, 
etc.  It  is  a  common  error  to  overlook  the  essential  condition  of 
the  disease.  The  Osteopath  who  gives  close  attention  to  a  class 
of  neurasthenic,  flat-chested,  constipated  patients,  who  complain 
of  lack  of  bodily  and  mental  vigor,  many  and  various  indefinite 
nervous  symptoms,  abdominal  pulsation,  vaso-motor  disturbance, 
etc.,  will  find  most  interesting  material.  The  multitude  of  symp- 
toms may  vary  greatly  in  different  cases,  but  the  presence  of 
neurasthenic  conditions,  altered  thorax  and  spine,  and  unnatural 
abdominal  condition,  either  of  walls,  viscera,  or  both,  will  usually 
afford  an  unmistakable  sign  of  the  disease.  After  a  little  experi- 
ence with  such  cases  one  learns  to  recognize  them  at  a  glance  when 
presented  for  examination.  Once  seen  these  cases  can  hardly 
be  mistaken,  and  a  few  moments  examination  reveals  a  story  of 
disease  beginning  imperceptibly,  the  growing  conviction  through 
many  months  or  some  years  that  something  was  wrong,  the  at- 
tempt to  seem  well  because  no  decided  disease  seemed  present, 
or  a  long  course  of  treatment  for  various  ills,  none  of  which  reach- 
ed the  true  condition.  This  most  common  disease  it  still  but  sel- 
dom clearly  recognized  or  intelligently  handled. 

LESIONS  AND  CAUSES:  The  common  description  of  its 
etiology  is  unsatisfactory.  Tight  lacing,  traumatism,  muscu- 


176  PRACTICE    OF    OSTEOPATHY. 

lar  strain,  and  repeated  pegnancies  are  mentioned.  The  con- 
dition of  relaxed  abdominal  walls  and  prominent  viscera  due  to 
repeated  pegnancies  may  probably  be  rightly  regarded  as  a  sep- 
arate condition.  It  is  due  to  a  physiological  act,  and  does  not 
present  those  specific  lesions  nor  the  resulting  symptoms  found 
in  neurasthenic  enteroptosis.  Tight  lacing,  traumatism,  and 
muscular  strain  may  produce  those  lesions  found  to  be  the  cause 
of  such  conditions. 

These  cases  commonly  present  spinal,  rib,  diaphragmatic 
and  abdominal  lesions.  Spinal  lesions  may  be  of  any  of  the  kinds 
found  in  the  spine  ordinarily,  and  may  occur  anywhere  along  the 
splanchnic  or  lumbar  region.  Rib  lesions  may  occur  in  any  or 
all  of  the  lower  six  ribs  on  either  side. 

Mobility  4of  the  tenth  rib  is  regarded  by  a  German  physi- 
cian, Dr.  B.  Stiller,  (Phil.  Med.  Journal,  Jan.  13,  1900,)  as  a  path- 
ognomonic  cause  of  enteroptosis.*  Undoubtedly  it  could  in- 
terfere with  the  sympathetic  connections  of  the  abdominal  vis- 
cera and  become  a  factor  in  causing  this  condition.  But,  from 
an  osteopathic  view-point,  lesions  of  other  ribs,  and  of  spinal 
vertebrae,  etc.,  may  be  as  potent  in  producing  the  "basal  neuro- 
pathy" concerned  in  this  disease  as  its  fundamental  pathologi- 
cal condition.  Further,  rib  lesions  may  cause  a  condition  of  the 
diaphragm  in  which  its  normal  tone  is  lost,  and  prolapse  in  it 
causes  ptosis  in  the  abdominal  organs  which  it  aids  in  support- 
ing. Spinal  lesions  may  participate  in  causing  the  atonic  con- 
condition  of  the  diaphragm. 

Spinal  and  rib  lesions,  aside  from  derangement  of  the  dia- 
phragm, acts  to  produce  enteroptosis  by  interfering  with  the 
spinal  sympathetic  connections  of  the  viscera  and  of  their  omental 
supports.  Impeded  circulation  and  nerve-supply,  vaso-motor, 
motor,  secretory,  trophic  and  sensory,  produces  at  the  same  time 
derangement  of  function  in  the  organs  and  weakness  in  their 
mesenteric  supports.  These  conditions  work  together  to  bring 
about  the  disordered  function  and  the  displacement  of  these  or- 
gans. The  displacement  of  itself  furthers  the  present  bad  con- 
ditions by  mechanically  interfering  with  the  activities  of  organs, 
stretching  nerve-fibers  and  blood-vessels  which  are  carried  in  the 

*"Boston  Osteopath,"  Jan.  14,  1900. 


PRACTICE    OF    OSTEOPATHY.  177 

now  elongated  omenta,  kinking  the  colon  at  various  points,  etc. 
The  viscera,  having  sunk  down  into  the  abdominal  cavity, 
cause  prominence  of  the  lower  abdomen,  leaving  a  hollow  in  the 
upper  abdomen,  thus  giving  to  it  the  peculiar  boat-shaped  ap- 
pearance described  as  "scaphoid  abdomen." 

Lower  dorsal  and  lumbar  lesion  may  interfere  with  the 
spinal  innervation  of  the  abdominal  walls,  cause  them  to  lose 
their  tone  and  to  dilate.  Intra-abdominal  pressure  is  thus  less- 
ened and  the  organs  are  allowed  to  prolapse. 

According  to  Byron  Robinson,  enteroptosis  begins  with  a 
weakening  of  the  abdominal  sympathetic,  which  loses  its  nor- 
mal power  over  circulation,  secretion,  assimilation  and  rhythm. 
That  this  weakness  of  the  abdominal  sympathetic  and  its  conse- 
quent loss  of  function  originates  in  spinal  lesion  to  its  origin  in 
the  splanchnic  nerves  has  already  been  pointed  out  and  fully 
discussed  in  considering  the  diseases  of  the  stomach  and  intes- 
tines, q.  v.  The  anatomical  relation  of  such  lesions  to  parts 
affected  was  pointed  out. 

The  PROGNOSIS  in  these  cases  is  very  favorable,  but  the 
progress  of  the  cure  is  likely  to  be  slow.  Generally  improve- 
ment begins  immediately  upon  treatment  and  may  progress  to 
a  cure  in  a  few  months.  Other  cases  yield  more  slowly,  though 
relief  is  soon  given,  and  require  an  extended  course  of  treatment 
to  effect  a  cure. 

The  TREATMENT  must  be  both  constitutional  and  local. 
The  latter  consists  in  the  removal  of  lesion  and  in  abdominal 
treatment.  Lesions  anywhere  to  the  .splanchnic  and  lumbar 
regions,  to  the  ribs,  thorax  and  diaphragm,  must  be  treated 
after  their  kind,  according  to  directions  given  in  Part  I.  With 
spine,  ribs,  and  diaphragm  restored  to  normal  condition,  the 
underlying  causes  of  the  enteroptosis  have  been  removed.  Cor- 
rected nerve  and  blood-supply  to  the  organs  and  their  supports 
aids  in  correcting  their  function  and  strengthens  the  supporting 
tissues  to  hold  them  in  place  when  restored  by  abdominal  manip- 
ulations. 

Correction  of  spinal  lesion  also  aids  in  restoring  nutrition 
and  tone  to  the  relaxed  and  atrophied  abdominal  walls.  This 
process  is  furthered  by  a  thorough  treatment  upon  the  abdom- 

12 


178  PRACTICE    OF    OSTEOPATHY. 

inal  walls.  This  renders  the  use  of  the  favorite  abdominal  band- 
age unnecessary,  and  it  is  gradually  laid  aside.  Throughout  the 
course  of  the  case  the  restored  abdominal  walls  act  as  the  band- 
age has  done  to  hold  the  organs  to  their  places  as  replaced  by  the 
treatment.  With  corrected  spine,  free  blood  and  nerve  supply 
to  all  the  visceral  supports,  and  a  strengthened  abdominal  wall, 
no  difficulty  is  found  in  getting  the  parts  to  gradually  be  retained 
in  their  normal  positions.  Thorough  spinal  stimulation  over  the 
splanchnic  and  lumbar  areas  is  kept  up  for  the  purpose  of  increas- 
ing the  blood  and  nerve-supply  to  the  parts  in  question. 

Abdominal  work,  aside  from  treatment  of  the  walls,  is  di- 
rected to  raising  and  replacing  the  viscera.  This  is  readily  ac- 
complished by  various  treatments.  (II,  III,  IV,  Chap.  VIII.) 
This  releases  and  renews  circulation  and  nerve  supply  at  the 
same  time,  removes  pressure  of  organs  upon  each  other,  gives 
freedom  of  motion,  and  aids  in  strengthening  the  omenta  to  hold 
the  parts  in  place. 

The  diaphragm  has  been  restored  to  normal  position,  and 
tone  by  correction  of  those  lesions  originally  deranging  it. 

The  constitutional  treatment  must  be  thorough  and  general 
to  restore  the  patient  from  the  nervous,  circulatory,  nutritional, 
and  other  effects  of  the  disease.  A  most  thorough  general  spinal 
treatment  must  be  given.  Thorough  stimulation  of  heart  and 
lungs,  treatment  of  the  cervical  sympathetic,  and  attention  to 
kidneys,  liver  and  skin  accomplishes  the  desired  object.  The 
auto-intoxication  usually  present  is  overcome  by  this  treatment 
of  the  excretory  organs.  The  constipation,  dyspepsia,  and  other 
functional  disorders  are  corrected  by  the  restoration  of  the  or- 
gans concerned. 

The  patient  should  be  much  out  of  doors,  free  from  worry, 
and  careful  not  to  become  fatigued.  Deep  breathing  exercises 
are  beneficial. 

PERITONITIS. 

DEFINITION:  An  acute  or  chronic  inflammation  of  the  peri- 
toneum, localized  or  general. 

CASES:  (1)  A  case  diagnosed  as  septic  peritonitis,  prob- 
ably caused  by  appendicitis,  under  the  care  of  celebrated  Chicago 


PRACTICE    OF   OSTEOPATHY.  179 

physicians  grew  steadily  worse  until  death  was  expected  in  a  few 
hours.  No  hopes  of  recovery  were  entertained,  and  it  was  evi- 
dent that  the  best  medical  treatment  was  of  no  avail.  As  a  last 
resort  an  Osteopath  was  finally  called,  all  medical  treatment  was 
discontinued,  and  the  treatment  began.  Immediately,  under 
the  treatment,  the  great  pain  that  had  been  present  for  hours  at 
a  time,  was  controlled,  and  during  the  next  four  weeks  not  two 
hours  pain  in  all  was  experienced.  The  other  symptoms  were 
also  discovered  upon  examination,  and  led  to  inquiry  concerning 
accident,  which  brought  out  the  fact  that  the  boy  had  had  a  ser- 
ious fall  a  few  weeks  before.  The  resulting  lesions  were  held  to 
be  the  primary  cause  of  the  peritonitis,  and  treatment  directed 
to  them  was  the  cardinal  treatment.  The  fact  that  the  child's 
life  was  saved  at  such  a  juncture,  in  disease  of  such  a  nature, 
by  the  removal  of  spinal  lesion,  is  a  convincing  demonstration 
of  the  correctness  of  osteopathic  theory  and  practice. 

The  LESIONS  expected  in  such  cases  are  to  the  lower  ribs, 
the  lower  dorsal  and  lumbar  spine,  and  sometimes  the  pelvis. 
In  such  cases  as  are  secondary  to  other  disease,  such  as  inflam- 
mation in  the  various  abdominal  organs,  typhoid  or  diphtheritic 
ulcer,  appendicitis,  volvulus,  etc.,  the  active  lesion  in  the  case 
must  be  sought  for  as  the  cause  of  the  primary  disease.  Such 
lesions  may  be  various. 

ANATOMICAL  RELATIONS:  The  nerve-supply  to  the  parietal 
peritoneum  is  from  the  lower  intercostal  and  upper  lumbar 
nerves,  which  supply  also  the  muscles  of  the  abdominal  walls. 
The  abdominal  sympathetics  also  supply  the  peritoneum,  being 
chiefly  vaso-motors  for  the  blood-vessels  in  the  mesentery,  but 
also  having  certain  branches  distributed  directly  to  the  substance 
of  the  peritoneum. 

The  blood-supply  is  from  the  cceliac  axis  through  the-  hepatic 
and  splenic  arteries,  and  from  the  blood-supply  of  the  parts  with 
which  the  various  portions  of  the  mesentery  are  in  relation. 

The  fact  that  the  chief  sympathetic  supply  to  the  perito- 
neum is  to  the  blood-vessels  in  it  is  a  significant  one. 

The  inflammation  of  peritonitis  is  a  vaso-motor  disturb- 
ance. It  has  been  before  explained  how  spinal  lenon  deranges 
spinal  sympathetic  connections  of  the  abdominal  sympathetic 


180  PRACTICE   OF    OSTEOPATHY. 

and  produces  disease.  Thus  certain  lesions  among  the  lower 
ribs,  and  along  the  lower  spine,  result  in  derangement  of  the  sym- 
pathetic, which,  when  affecting  the  peritoneum,  becomes  a  chiefly 
vaso-motor  disturbance  because  of  the  peritoneal  sympathetics 
being  mostly  vaso-motors,  and  the  inflammation  results. 

In  another  way.  these  lesions,  affecting  the  lower  intercostal 
and  upper  lumbar  spinal  nerves,  may  become  the  active  cause 
of  peritonitis.  Hilton  shows  that  these  nerves,  supplying  the 
skin  and  muscles  of  the  abdominal  walls,  as  well  as  the  parietal 
peritoneum,  probably  also  supply  the  visceral  peritoneum  and 
send  sensory  branches  through  the  sympathetic  to  the  intestinal 
walls.  Quain's  anatomy  shows  that  from  the  9th,  10th,  llth 
and  12th  dorsal  nerves,  sensory  nerves  pass  through  the  sym- 
pathetic to  the  abdominal  viscera.  It  also  shows  that  from  thor- 
acic sympathetic  and  from  the  lumbar  sympathetic  cord,  vaso- 
motor  fibres  of  the  abdominal  vessels  take  origin.  The  intimate 
relation  between  the  spinal  and  sympathetic  nerves  is  well  known. 
Hilton  uses  the  facts  he  points  out  in  regard  to  this  connected 
nerve  mechanism  to  explain  why  the  abdominal  walls  become 
painful  and  contracted  from  the  inward  irritation  of  the  inflam- 
mation. The  connection  of  this  nerve  mechanism  for  all  these 
related  parts  also  explains  how  lower  rib,  lower  dorsal,  and  upper 
lumbar  spinal  lesions  may  so  interfere  with  vaso-motor  supply  to 
the  peritoneal  vessels  as  to  cause  peritonitis.  This  immense 
abdominal  nerve-supply,  both  superficial  and  internal,  spinal 
and  sympathetic,  offers  the  Osteopath,  both  through  its  sur- 
face distribution,  its  spinal  connections,  arid  its  internal  distrib- 
ution, a  vast  and  most  readily  accessible  field  for  his  work  by 
superficial  and  deep  abdominal  and  spinal  treatment.  This 
fact  well  explains  his  good  results,  even  in  bad  cases,  in  gaining 
control  of  the  vaso-motor  mechanism  which  is  deranged  in  this 
inflammation. 

Through  the  connection  of  this  local  vaso-motor  mechan- 
ism with  the  vaso-motor  system  of  the  whole  body,  reflex  irrita- 
tion is  set  up  which  leads  to  a  general  vaso-constriction  of  the 
vessels  of  the  whole  body  surface.  Robinson  thus  explains  why 
the  whole  skin  is  waxy  pale  and  cold,  saying  that  the  j  atirnt. 
on  this  account,  dies  from  circumference  to  center. 


PRACTICE    OF    OSTEOPATHY.  181 

Robinson  also  shows  that  traumatic  action  of  the  left  end 
of  the  diaphragmatic  muscle  upon  the  gut  wall,  of  the  psoas 
magnus  upon  the  sigmoid,  and  abrasion  of  the  bowel  mucosa 
at  the  splenic  and  sigmoid  flexures,  very  frequently  become  the 
causes  of  peritonitis  by  allowing  the  migration  and  foot-hold  of 
pathogenic  bacteria.  Spinal,  or  other  specific  osteopathic  le- 
sion, by  causing  bad  bowel  conditions  which  allow  of  the  possi- 
bility of  such  traumatism,  may  be  present,  and  must  be  removed 
in  the  treatment  for,  or  the  prophylaxis  of,  this  disease.  . 

The  PROGNOSIS  in  these,  cases  "Is  fair.  Considering  that 
peritonitis  patients  often  die  under  medical  treatment  in  the 
acute  form  of  the  disease,  and  that  operation  must  frequently 
be  resorted  to,  the  success  osteopathy  has  had  with  serious  cases 
is  marked. 

The  TREATMENT  must  aim  at  gaining  vaso-motor  control 
and  thus  reducing  the  inflammation.  Lesion  must  be  corrected 
as  soon  as  possible.  The  treatment  must  be  both  spinal  and 
abdominal.  The  first  step  should  be  thorough  but  careful  re- 
laxation of  all  spinal  tissues.  If  the  patient  cannot  be  turned 
upon  his  side,  he  may  continue  to  lie  upon  his  back,  and  the 
operating  hand  may  be  slipped  under  him  to  work  along  the 
spine.  Inhibition  should  be  made  along  the  splanchnic  and 
upper  lumbar  regions,  especially  from  the  9th  to  12th  dorsal,  to 
quiet  the  pain  through  inhibition  of  the  sensory  fibres.  After 
spinal  relaxation  and  inhibition,  the  abdominal  treatment  will 
be  better  borne.  Through  this  spinal  treatment  effect  upon 
vaso-motor  activities  is  gained  by  way  of  the  sympathetic  con- 
nections explained  above.  This  aids  in  freeing  the  circulation. 
During  the  progress  of  the  treatment  of  the  case,  the  inhibitive 
spinal  treatment  may  be  alternated  with  a  thorough  stimulation 
of  the  sympathetic  connections  of  the  parts  involved,  to  check 
peristalsis.  As  soon  as  possible,  thorough  general  spinal 
treatment  should  be  given  to  equalize  the  general  circulation, 
and  to  overcome  the  intense  vaso-constriction  of  all  the  super- 
ficial vessels,  so  noticeable  a  feature  of  the  case.  Heart  and 
lungs  should  be  stimulated,  and  inhibition  of  the  superior  cer- 
vical region  be  made. 

After  spinal  inhibition   very  light   abdominal   treatment  is 


182  PRACTICE    OF   OSTEOPATHY. 

given.  The  walls  are  tense  and  painful,  and  much  care  is  re- 
quired in  treating  them.  The  treatment  should  be  gentle,  re- 
laxing, and  inhibitive,  thus  relaxing  the  contractured  muscles, 
aiding  general  circulation,  and  decreasing  pain.  On  account 
of  the  relation  between  the  nerves  of  the  abdominal  walls  and 
those  of  the  inward  parts  involved,  as  pointed  out  above,  work 
upon  the  abdominal  walls  has  an  important  corrective  effect 
upon  the  morbid  conditions  present  internally.  The  theory 
that  work  upon  nerve  terminals  affects  parts  supplied  by  con- 
nected nerves  is  well  supported  by  fact.  Thus  restoration  of  a 
relaxed  and  natural  condition  of  the  abdominal  walls  is  an  im- 
portant aid  in  restoring  natural  conditions  in  the  parts  supplied 
by  these  connected  nerves.  Gradually,  deeper  work  may  be 
done,  affecting  the  abdominal  sympathetic  locally,  increasing 
circulation  and  stimulating  absorption  of  the  inflammatory 
effusions  and  other  products.  Care  must  be  taken  in  the  treat- 
ment over  the  intestines,  as  their  walls  are  intensely  gorged  with 
blood,  and  are  friable. 

The  obstinate  constipation  present  is  due  to  pressure  from 
congestion  of  the  bowel  walls,  and  by  edema  into  them,  check- 
ing peristalsis.  As  the  circulation  is  restored  this  condition  is 
corrected,  and  bowel  action  can  be  stimulated  by  the  usual  means. 
The  liver,  kidneys,  and  skin  should  be  stimulated  to  aid  in  carry- 
ing off  the  effusions  and  the  effete  products  of  the  disease.  The 
hiccough  is  relieved  by  inhibition  of  the  phrenic  nerve  (VIII, 
Chap.  III).  Treatment  for  the  fever  and  for  the  vomiting  and 
tympanites,  is  applied  as  before  directed.  The  treatment  pre- 
vents the  formation  of  adhesions,  and  takes  down  the  thickening 
of  the  peritoneum.  The  patient  should  be  kept  quiet  in  bed, 
no  food  should  be  allowed  as  long  the  vomiting  occurs.  Later 
a  restricted  liquid  diet  is  used  in  small  amounts  at  a  time.  Crack- 
ed ice  may  be  used  to  allay  the  thirst.  Rectal  injections  may  be 
necessary  to  relieve  the  constipation  at  first. 

The  treatment  of  the  chronic  case  is  directed  to  the  gradual 
breaking  down  of  adhesions;  the  restoration  of  circulation  to 
absorb  pus  or  effusion,  and  to  remove  the  chronic  inflammation; 
and  to  the  relaxation  of  the  abdominal  tissues.  Correction  of 
the  spinal  lesion  must  not  be  neglected. 


PRACTICE  OF  OSTEOPATHY.  183 

Cases  of  acute  peritonitis  secondary  to  other  diseases  must 
be  treated  in  conjunction  with  them.  Cases  resulting  from 
gunshot  wounds  and  other  traumatism  are  surgical  cases.  In 
the  acute  case  the  patient  should  be  seen  two  or  three  times  per 
day  as  long  as  the  severe  acute  symptoms  predominate. 

ASCITES,  (HYDROPERITONEUM.) 

DEFINITION:  A  dropsical  condition  of  the  abdomen,  due 
to  an  accumulation  of  serous  fluid  in  the  peritoneal  sac. 

CASES:  (1)  Ascites  following  malarial  fever,  and  of  more 
than  one  years  standing.  The  condition  was  so  pronounced  that 
the  patient  could  walk  but  little.  Lesion  was  present  as  a  down- 
ward displacement  of  each  llth  rib,  and  the  whole  lumbar  re- 
gion of  the  spine  \vas  affected.  The  pulse  was  156.  Under 
treatment  rapid  improvement  took  place.  The  pulse  was  re- 
duced to  82,  and  the  patient  was  able  to  go  to  work. 

(2)  A  case  of  ascites  which  had  suffered  from  the  condition 
two  times  previously,  at  one  time  for  fourteen  years,  at  another 
for  one  year.     Recovery  was  made  from  these  attacks,  but  the 
disease  again  developed  after  an  attack  of  the  grippe,  and  was 
not  relieved  by  the  means  which  had  before  been  successful. 
It  was  of  three  years  standing  when  it  came  under  osteopathic 
care.     After  the  seventh  treatment  the  dropsical  fluid  began  to 
be  absorbed  into  the  circulation  and  thrown  off  by  the  kidneys. 
Ten  pounds  of  fluid  were  excreted  every  twenty-four  hours,  and 
the  patient's  weight  was  rapidly  reduced  from  190  to  153  pounds. 

(3)  See  Cirrhosis  of  the  Liver,  case  (1). 

The  LESIONS  in  this  disease  are  various,  as  it  is  commonly 
a  condition  secondary  to  some  other  disease,  as  of  the  heart, 
lungs,  kidneys,  liver,  etc.  Lesions  must  be  expected  -  accord- 
ing to  the  nature  of  the  primary  disease.  If  it  be  due  to  a  local 
condition,  such  as  obstructed  portal  circulation  (see  Cirrhosis 
of  the  Liver),  peritonitis,  q.  v.,  or  abdominal  tumor,  the  lesions 
expected  are  the  ones  usually  fonnd  in  these  conditions.  Lesions 
in  the  splanchnic  area,  the  upper  lumbar  region,  and  among  the 
lower  ribs  occur  often  in  these  cases  as  underlying  causes,  determin- 
ing the  local  manifestation  of  the  disease  through  interference 
with  the  sympathetic  innervation  of  the  abdominal  vessels,  as 
before  explained. 


184  PRACTICE    OF    OSTEOPATHY. 

The  vast  area  and  capacity  of  the  abdominal  veins,  the 
ease  with  which  they  are  dilated,  and  the  relation  of  the  portal 
circulation  to  the  liver,  together  with  the  frequent  presence 
of  lesions  in  the  splanchnic  and  upper  lumbar  regions  of  the 
spine,  weakening  vaso-motor  control  of  these  vessels,  are  no 
doubt  important  anatomical  factors  in  determining  the  dropsy 
to  the  abdominal  region. 

The  PROGNOSIS  in  these  cases  depends  upon  that  for  the 
condition  producing  the  trouble.  Generally  speaking,  it  is  good 
except  in  cases  of  atrophic  cirrhosis  of  the  liver. 

The  TREATMENT  for  ascites  consists  chiefly  in  the  treatment 
of  the  disease  to  which  it  is  secondary.  Special  lesion  as  found 
must  be  removed.  Obstructed  circulation  must  be  opened, 
general  abdominal  circulation  stimulated,  and  the  collateral 
circulation  through  the  superficial  abdominal  veins  developed. 
This  is  accomplished  by  spinal  correction  and  stimulation  of  the 
splanchnic  and  lumbar  vaso-motor  areas.  The  solar  and  other 
abdominal  plexuses  are  stimulated,  and  deep  abdominal  manip- 
ulation is  made  from  below  upward  along  the  course  of  the  vena- 
cava  and  azygos  veins,  the  portal  vein,  and  the  superficial  ab- 
dominal veins.  Thorough  stimulation  of  the  liver  and  portal 
circulation  is  the  most  important  factor  in  the  treatment  of  this 
condition.  (See  Cirrhosis  of  the  Liver).  Treatment  over  the 
course  of  the  superficial  abdominal  veins  results,  in  the  course 
of  a  few  treatments,  in  considerable  enlargement  of  them.  As 
circulation  is  corrected  the  dropsical  process  is  checked,  and  ab- 
sorption of  fluid  already  effused  begins  to  take  place.  Stimula- 
tion of  kidneys,  bowels,  and  skin  aid  the  process.  The  disten- 
tion  of  the  abdomen  may  considerably  hinder  the  treatment. 
By  laying  the  patient  upon  his  side,  so  that  the  fluid  gravitates 
away  from  the  uppermost  side,  the  latter  may  be  treated  by  deep 
manipulation.  The  patient  may  then  be  laid  on  the  other  side, 
and  the  process  be  repeated.  On  account  of  the  accumulation 
of  fluid,  paracentesis  may  have  to  be  performed,  but  ordinarily 
under  osteopathic  treatment  tapping  does  not  become  necessary, 
except  in  cases  of  atrophic  cirhosis  of  the  liver.  The  lower  limbs 
should  be  treated  to  increase  circulation  in  them  and  to -empty 
their  dilated  vens. 

The  patient  should  be  treated  daily. 


PRACTICE  OF  OSTEOPATHY.  185 

JAUNDICE. 

DEFINITION:  A  condition  in  which  bile  is  absorbed  into 
the  circulation  and  colors  the  tissues  of  the  body  and  the  secre- 
tions. 

CASES:  (1)  Lesion  from  overexertion,  in  the  form'  of  a 
"twist"  between  the  6th  and  7th  dorsal  vertebrge.  Jaundice 
followed  immediately  after  its  occurrence.  (2)  9th  and  10th 
dorsal  vertebrae  anterior;  intense  congestion  of  the  deep  mus- 
cles of  the  right  cervical  region;  looseness  of  the  7th  cervical 
vertebra.  (3)  Catarrhal  jaundice  following  difficult  child-birth; 
extreme  tenderness  of  the  spine  from  the  10th  dorsal  to  the  1st 
lumbar.  (4)  Jaundice  and  constipation  in  a  lady  of  23.  The 
jaundice  was  of  several  months  standing.  There  was  a  lateral 
lesion  of  the  10th  dorsal  vertebra,  with  marked  rigidity  of  mus- 
cles and  ligaments  in  the  lower  dorsal  and  lumbar  regions.  The 
case  was  practically  cured  in  one  month.  (5)  Jaundice  of  four 
years  standing.  There  was  external  tenderness  in  the  legion  of 
the  hepatic  flexure  of  the  colon;  luxation  of  the  10th  right  rib: 
posterior  condition  of  the  9th  to  llth  dorsal.  Correction  of  le- 
sions, with  occasional  abdominal  treatment,  cured  the  case  in  4 
months. 

LESIONS  AND  CAUSES:  Spinal  lesion  anywhere  along  the 
•splanchnic  area  has  been  known  to  produce  the  disease.  Lesion 
of  the  lower  right  ribs  is  common.  Prolapsus  of  the  transverse 
colon,  due  to  various  lesions  (see  Intestinal  Obstruct  ion  and  En- 
teroptosis),  may  obstruct  the  duct  by  compression.  Various 
mechanical  causes;  stricture,  gall-stones,  parasites,  tumors,  etc., 
are  well  known  as  causes  of  obstructed  bile-flow,  leading  to  ob- 
structive jaundice.  The  relation  of  lesion  to  these  causes,  "osteo- 
pathically,  is  found  in  the  agency  of  various  lesions,  whose  na- 
ture and  action  are  well  understood  from  discussions  in  the  pre- 
vious pages,  in  producing  diseased  conditions  of  the  gastro-in- 
testinal  tract  leading  to  the  presence  of  such  obstructive  agents. 

ANATOMICAL  RELATIONS:  The  relation  between  spinal  and 
other  lesion  and  abnormal  liver  conditions  will  be  discussed  (see 
Cirrhosis  and  Gall-stones).  In  catarrhal  jaundice,  the  usual  form 
presented  for  treatment  as  jaundice,  lesion  has  occurred  in  the 


186  PRACTICE    OF    OSTEOPATHY. 

splanchnic  area  and  is  interfering  with  vaso-motor  activing  of  the 
gastro-intestinal  tract,  producing,  or  allowing  other  causes  to 
produce,  an  inflamed  condition  of  the  mucous  membrane  of  the 
gastro-duodenal  mucosa  and  of  the  mucous  lining  of  the  ductus 
communis. 

The  immediate  appearance  of  jaundice  after  spinal  lesion, 
as  in  case  1  cited  above,  as  well  as  the  presence  of  spinal  lesion 
in  other  cases  of  jaundice,  favors  the  probability  of  direct  inter- 
ference of  such  lesions  with  the  innervation  of  the  gall-bladder 
and  duct.  The  presence  in  the  sympathetic  supply  of  the  liver 
(hepatic  and  cystic  plexuses,  see  Gall-Stones)  of  spinal  fibers 
which,  upon  stimulation  or  inhibition  of  the  splanchnics,  cause 
constriction  or  dilatation  of  the  bladder  and  ducts;  also  the  fact 
that  stimulation  of  the  pneumogastrics  constricts  the  bladder, 
while  relaxing  the  sphincter  of  the  opening  of  the  common  duct 
into  the  duodenum,  make  it  probable  that  certain  lesion  to  the 
splanchnic  area  or  to  the  pneumogastric,  directly  or  indirectly 
through  its  sympathetic  connections,  might  so  pervert  the  nor- 
mal wrorkings  of  this  mechanism  as  to  lead  to  retention  of  bile, 
i.  e.,  a  form  of  obstructive  jaundice. 

The  PROGNOSIS  is  good.  The  acute  case  yields  immedi- 
ately to  treatment.  The  usual  course  (two  to  eight  weeks)  is 
materially  shortened.  In  the  chronic  case,  clearing  of  the  tis- 
sues from  the  pigmentation  is  rather  a  slow  process. 

The  TREATMENT  must  look  at  once  to  the  removal  of  such 
active  lesion  as  described  above.  Mechanical  obstruction  must 
be  located  if  possible  and  removed  by  work  upon  'the  duct,  pro- 
ceeding upon  the  lines  laid  down  for  the  manipulative  removal 
of  gall-stones  and  of  intestinal  obstructions,  q.  v.  Prolapsus 
of  the  intestines  and  pressure  from  surrounding  organs  must  be 
relieved  (see  Enteroptosis) . 

In  catarrhal  jaundice  the  first  step  must  be  to  gain  vaso- 
motor  control  and  relieve  the  inflammation.  A  preliminary 
inhibition  of  the  splanchnic  area  of  the  spine  may  be  necessary 
to  relieve  pain  and  to  gain  a  degree  of  relaxation  of  abdominal 
tissues  before  local  work  is  attempted.  Next,  slow,  deep,  inhi- 
bitive  or  relaxing  treatment  is  directed  to  the  upper  intestinal 
egion  and  ductus  communis.  This  relieves  the  inflammation, 


PRACTICE    OF   OSTEOPATHY.  187 

aids  in  taking  down  the  swelling  of  the  mucous  membrane,  and 
frees  the  secretion  of  mucous  which  may  be  obstructing  the  duct. 
At  the  same  time,  treatment  of  the  splanchnics  aids  in  correcting 
circulation  in  the  parts. 

After  treatment  for  the  inflammation  and  relaxation  of  the 
duct,  the  next  step  is  the  emptying  of  the  gall-bladder  and  hepatic 
ducts.  This  is  done  by  local  manipulation  which  acts  mechanic- 
ally and  by  stimulation  of  the  hepatic  and  cystic  plexuses.  The 
patient  lies  upon  his  back  and  the  operator  stands  at  the  left 
side;  he  places  the  palm  of  the  right  hand  beneath  the  postero- 
lateral  aspect  of  the  lower  four  right  ribs  and,  while  raising  them, 
presses  down  upon  their  anterior  portions  with  the  right  fore- 
arm. At  the  same  time  the  left  hand  makes  careful  but  deep 
pressure  beneath  the  tip  of  the  ninth  rib,  against  the  fundus  of 
the  gall-bladder.  This  mechanically  empties  the  liver  and  ducts. 
It  also  stimulates  the  local  cystic  plexus  to  cause  constriction  of 
the  bladder  and  ducts. 

This  same  treatment,  and  the  lower  costal  treatment  (V. 
Chap.  VIII),  carefully  applied,  are,  given  to  regulate  the  circu- 
lation through  the  liver  and  to  free  it  of  accumulated  bile.  The 
splanchnics  should  also  be  thoroughly  treated  for  the  circula- 
tion. By  these  treatments  the  flow  of  bile  is  increased,  and  the 
system  is  cleared  of  it.  Thorough  stimulation  of  the  kidneys 
and  skin  (2d  dorsal,  5th  lumbar)  aids  in  freeing  the  blood  of  the 
bile  acids.  This  allays  the  itching.  The  superior  cervical  re- 
gion (medulla)  should  be  inhibited  to  correct  general  vaso-motor 
action.  This  is  for  the  itching  and  localized  sweating.  The 
bowels  and  stomach  must  be  treated  to  relieve  the  constipation 
or  diarrhoea,  and  the  dyspepsia,  as  before  directed.  Other  symp- 
toms may  be  allayed  by  appropriate  treatment. 

The  diet  should  be  plain,  avoiding  pastry,  starchy,  fatty, 
and  saccharine  foods.  Plenty  of  water  should  be  drunk ;  lemonade 
and  alkaline  drinks  are  allowed.  Skimmed  milk  and  butter- 
milk, lean  meat,  soups,  bread,  and  green  vegetables  may  be 
used.  Frequent  bathing  is  good  to  aid  elimination  and  to  clear 
the  skin  and  restore  its  healthy  condition. 

In  toxemic  jaundice  the  main  object  of  treatment  must  be 
the  removal  from  the  system  of  the  poison  that  is  causing  the 


188  PRACTICE    OF   OSTEOPATHY. 

trouble.  If  due  to  a  toxic  disease,  the  treatment  must  be  to  it. 
In  any  such  case  all  the  avenues  of  excretion  must  be  kept  active 
to  cleanse  the  system.  The  usual  liver  treatments  etc.,  may  be 
also  applied. 

CONGESTION  OF  THE  LIVER. 

DEFINITION:  An  excess  of  blood  in  the  vessels  of  the  liver. 
In  active  congestion,  or  acute  hyperemia,  an  excess  of  arterial 
blood  is  circulating  through  it.  In  passive  congestion  the  liver 
is  engorged  by  retention  of  blood  in  its  portal  circulation. 

CASES:  (1)  A  case  of  active  congestion,  which  was  in  a 
dangerous  condition.  Lesion  was  present  as  a  severe  contrac- 
tion of  the  muscles  on  the  right  side  of  the  spine,  from  the  6th  to 
12th  vertebra.  The  intercostal  muscles  over  the  liver  were  also 
contracted.  (2)  Active  congestion  in  a  woman  of  45,  of  two 
weeks  standing.  There  was  muscular  lesion  in  the  region  of  the 
splanchnics. 

The  LESIONS  already  discussed  in  connection  with  liver  dis- 
eases, i.  e.,  these  of  the  splanchnic  area  and  of  the  lower  ribs,  in- 
terfering with  the  -vase-motor  control  of  the  organ,  lead  to  the 
congestion.  Heart  and  lung  diseases  are  said  to  be  almost  always 
the  causes  of  passive  congestion,  but  the  ordinary  congested  liver, 
found  in  dyspepsia,  biliousness,  constipation,  etc.,  is  due,  not  to 
heart  or  lung  disease,  but  to  lesions  in  the  splanchnic  area.  The 
lesions  here  must  be  sought  according  to  the  case,  and  treat- 
ment made  as  thus  indicated. 

The  PROGNOSIS  is  good.  These  cases  are  usually  readily 
cured. 

The  TREATMENT  is  merely  one  to  gain  vaso-motor  control. 
Thorough  stimulation  of  the  splanchnic  area  and  solar  and 
hepatic  plexuses  is  an  important  means  of  accomplishing  this. 
The  lower  costal  and  direct  liver  treatment  indicated  for  jaun- 
dice, q.  v.,  are  used.  Besides  directly  stimulating  the  local 
nerve  mechanism,  these  treatments,  by  squeezing  the  liver  and 
mechanically  forcing  the  blood  into  and  out  of  it,  cause  the 
mechanical  action  of  the  blood  upon  the  vessel  walls  to  still 
further  arouse  vaso-motor  activity.  Local  treatment  should  be 
made  upon  the  liver  to  stimulate  the  flow  of  bile  and  prevent 


PRACTICE  OF  OSTEOPATHY.  189 

jaundice.  A  general  spinal,  neck,  and  abdominal  treatment  aids 
in  correcting  general  circulation.  Treatment  for  the  abdominal 
vessels  quiets  active  congestion  by  dilating  the  abdominal  ves- 
sels and  drawing  the  blood  to  them. 

In  active  hyperemia  correct  errors  in  diet,  and  avoid  the 
use  of  highly  seasoned  food  and  alcohol.  A  milk  diet  is  good. 
Keep  the  bowels  active. 

In  passive  hyperemia  look  well  to  the  condition  of  the  heart. 
Keeping  it  stimulated.  Due  attention  should  also  be  given  to 
the  lesser  circulation. 

CIRRHOSIS  OF  THE  LIVER,  (SCLEROSIS  OF  THE  LIVER.) 

DEFINITION:  A  chronic  disease,  characterized  by  an  in- 
crease of  connective  tissue  in  or  about  the  liver. 

CASES:  (1)  Atrophic  cirrhosis;  a  case  brought  on  by  social 
drinking,  diagnosed  and  treated  by  physicians  as  such.  The 
first  tapping  of  the  abdoment  brought  eight  and  one-half  quarts 
of  fluid.  The  case  now  came  under  osteopathic  treatment,  and 
it  succeeded  so  well  that  a  second  tapping  was  delayed  some 
time  beyond  the  expected  time.  Later  a  third  tapping  became 
necessary,  after  that  none  was  required.  Under  the  treatment 
the  patient  was  retsored  to  perfect  health. 

(2)  Diagnosis  of  cirrhosis;  6th  and  7th  dorsal  vertebrae  pos- 
terior, 9th  to  12th  flat;  ribs  irregular  and  prominent  on  left. 

(3)  Malarial  cirrhosis;  entire  lumbar  region  bad;  llth  rib 
on  each  side  down. 

LESIONS  AND  CAUSES:  The  lesions  commonly  found  in 
these  cases  affect  the  splanchnic  area,  the  lower  ribs  on  each 
side,  or  the  lower  right  ribs.  The  latter  may  cause  mechanical 
pressure  and  irritation  upon  the  liver.  The  various  lesions 
weaken  the  vaso-motor  sympathetic  supply  and  lay  it  liable  to 
the  action  of  special  causes  of  the  disease. 

In  those  forms  of  cirrhosis  in  which  ascites  develops,  the 
contraction  of  the  connective  tissue  causes  pressure  upon  the 
soft  walls  of  the  branches  of  the  portal  vein.  Upon,  this  account, 
and  because  of  the  low  pressure  of  the  blood  in  the  portal  system, 
obstruction  soon  follows,  and  ascites  results. 

The  PROGNOSIS  must  be  guarded  in  all  cases.     Various  cases 


190     *  PRACTICE    OF    OSTEOPATHY. 

have  been  cured,  among  them  even  atrophic  cirrhosis.  In  the 
latter  case  the  prognosis  is  very  unfavorable.  It  is  probable 
that  other  forms  of  the  disease  can  be  much  benefited  or  cured 
under  the  treatment  in  many  instances. 

The  TREATMENT  aims  at  gaining  vaso-motor  control,  and 
thus  taking  down  the  inflammatory  or  congestive  process  that 
is  allowing  of  the  increase  in  connective  tissue.  In  those  forms 
complicated  with  ascites  as  the  main  symptom,  special  atten- 
tion must  be  given  to  it  as  being  most  immediately  dangerous 
to  the  patient's  life.  (See  Ascites.)  It  is  doubtful  if  connective 
tissue,  once  formed,  could  be  absorbed  by  the  renewed  blood- 
supply.  But  the  process  of  its  formation  could  be  stopped,  the 
liver  substance  could  be  kept  softened  by  thorough  work  locally 
over  the  organ,  thus  preventing  hardening  and  contractions  of 
it,  and  maintaining  freedom  of  circulation  through  it.  In  this 
way  danger  of  ascites  could  be  avoided. 

Vaso-motor  control  is  gained  by  removal  of  lesion,  by  thor- 
ough stimulation  of  the  splanchnic  area  of  the  spine,  and  by 
local  abdominal  work  over  the  liver  and  over  the  course  of  the 
portal  vein. 

Local  work  may  be  done  as  described  in  V.  Chap.  VIII, 
working  beneath  the  right  ribs,  directly  upon  the  liver,  while 
the  pressure  from  above  upon  the  ribs,  pressing  them  down  upon 
the  liver,  alternating  with  what  that  applied  directly  to  the 
liver,  is  an  efficient  mode  of  stimulating  the  organ  directly. 

In  atrophic  cirrhosis  attention  must  be  given  to  relieving 
the  congestion  of  the  spleen,  stomach  and  intestines  present. 
This  is  done  through  treatment  of  the  organs  as  described  in 
considering  diseases  of  them.  In  case  of  the  spleen  only  slight 
treatment  should  be  made  over  it  locally  on  account  of  danger  of 
rupture.  Stimulation  of  the  lower  splanchnic  area  and  raising 
the  lower  four  left  ribs,  together  with  work  upon  the  solar  plexus 
and  the  abdominal  circulation,  are  sufficient  for  it.  The  consti- 
pation, gastric  catarrh,  nausea,  vomiting,  edema  of  the  lower 
extremities,  etc.,  are  treated  as  before  described. 

In  biliary  cirrhosis,  the  chief  object  of  treatment  is  to  rt 
move  the  obstruction  to  the  duct  and  to  empty  the  gall-bladder 
(IX,   Chap.   VIII.)     The  general   corrective   treatment  for    the 


PRACTICE    OF   OSTEOPATHY.  191 

liver  as  described  is  relied  upon  to  soften  the  new  tissue  about 
the  small  ducts  and  to  prevent  its  further  formation. 

In  congestive  and  malarial  cirrhosis  the  chief  point  is  to  re- 
move and  prevent  the  congestion.  Otherwise  the  treatment  is 
as  indicated  for  the  general  case. 

In  hypertrophic  cirrhosis  the  main  indication  is  to  prevent 
the  formation  of  new  connective  tissue,  or  to  limit  its  forma- 
tion. This  connective  tissue  does  not  usually  show  a  tendency 
to  contract,  as  in  atrophic  cirhosis.  Possibly  much  might  be 
done  by  renewed  and  stimulated  circulation  to  absorb  this  tis- 
sue, since  fibroid  tumors  have  been  removed  by  like  means.  The 
kidneys  must  be  kept  well  stimulated,  as  the  amount  of  urine  is 
decreased.  Careful  treatment  must  be  done  about  the  spleen 
and  abdomen,  as  the  former  is  enlarged  and  tender,  and  there 
may  arise  perisplenitis  and  peritonitis.  Such  complications 
may  be  avoided  by  proper  attention  to  the  circulation,  etc.  The 
heart  and  general  circulation  must  be  looked  after,  to  prevent 
cardiac  complications  and  hemorrhages. 

In  all  cases  the  general  treatment  outlined,  with  attention 
to  the  special  symptoms  manifested,  should  be  applied. 

In  acute  cases  the  patient  should  be  seen  daily. 

GALL-STONES. 

DEFINITION:  Concretions  in  the  gall-bladder,  chiefly  of 
cholesterin,  due  to  a  pathological  process  usually  caused  by 
spinal  lesion  to  sympathetic  nerves  in  charge  of  liver  functions. 

CASES:  Very  numerous  cases  of  gall-stones,  some  of  them 
noted,  have  been  successfully  treated.  It  is  one  of  the  most 
common  things  treated,  and  in  no  class  of  cases  have  more  uni- 
formly good,  even  striking,  results  been  attained. 

(1)  In  a  case  of  gall-stones,  with  chronic  constipation  and 
dysmenorrhoea,  the  muscles  of  the  lower  dorsal  region  were  much 
contracted,  and  there  was  lesion  between  the  llth  and  12th  dor- 
sal vertebrse.     The  case  was  cured. 

(2)  A  case  of  gall-stones  after  typhoid  fever,  in  which  oper- 
ation had  been  advised.     The  stones  were  passed  under  osteo- 
pathic  treatment. 

(3)  A  serious  case  of  gall-stones  and  catarrh  of  the  stomach, 


192  PRACTICE    OF    OSTEOPATHY. 

V 

in  which  every  medical  means  of  cure  had  been  tried  without 
avail.  The  patient  grew  continually  worse.  After  a  few  osteo- 
pathic  treatments  the  stones  began  to  pass,  and  a  large  number  of 
them,  a  large  sized  teacupful  were  gotten  rid  of.  After  this  a 
copious  passage  of  mucus,  amounting  to  several  pints,  took  place. 
Much  of  the  mucous  membrane  lining  of  the  intestines,  gall- 
bladder, duct  and  stomach  was  cast.  The  stones  continued  to 
pass,  and  two  as  large  as  a  man's  thumb  were  among  them.  At 
the  passage  of  the  last  large  stone  the  patient's  limbs  and  lips 
were  paralyzed,  and  her  condition  became  critical.  The  crisis 
was  safely  passed  under  treatment,  however,  and  entire  recovery 
followed. 

(4)  In  man  of  45,  who  had  been  troubled  for  years  with 
gall-stones,   the   common   bile-duct   became  impacted,   and   the 
ordinary  methods  of  treatment  were  of  no  avail.     Hypodermic 
injections  of  morphine  gave  no  relief  from  the  pain,  and  an  oper- 
ation was  advised.     The  intense  pain  was  relieved  at  the  first 
treatment,  which  opened  the  duct.     After  the  second  treatment 
thirty  stones  passed  from  the  bowel.     The  case  was  entirely  cured. 

(5)  A  case  of  gall-stones  of  18  years  standing,  lesion  was 
found  as  a  depression  of  the  10th  right  rib,  infringing  the  10th 
intercostal  nerve,  which  was  sensitvie  along  its  entire  course. 
The  treatment  was  directed  to  the  lesion,  and  to  the  gall-bladder 
and  duct.     By  two  treatments,  the  colic  and  pain  were  overcome, 
and  the  case  entirely  recovered  under  further  treatment. 

The  LESIONS  found  in  these  cases  are  usually  low  down  in 
the  splanchnic  area,  affecting  the  lower  four  ribs  upon  either 
side,  frequently  upon  the  left,  for  the  spleen.  Lesions  of  the 
llth  and  12th  vertebrae  may  not  be  too  low  to  cause  it.  How- 

•  * 

ever,  any  of  those  lesions  to  the  ribs  and  splanchnic  area,  charac- 
teric  of  bad  gastro-intestinal  conditions  may,  from  the  nature  of 
the  case,  affect  the  liver  to  produce  gall-stones.  The  liver  is 
innervated  from  the  same  nerve-supply,  gastro-intestinal  dis- 
eases are  usually  complicated  with  deranged  liver  function,  and 
it  is  reasonable  to  find  in  the  usual  lesions  producing  the  latter 
a  sufficient  cause  for  disease  in  the  former,  which,  owing  to  some 
particular  form,  degree,  or  concentration  of  lesion,  results  in 
cholelithiasis. 


PRACTICE   OF    OSTEOPATHY.  193 

ANATOMICAL  RELATIONS  of  lesion  to  disease:  The  liver 
is  supplied  by  the  splanchnics  through  the  solar  plexus,  the  sec- 
ondary plexus,  the  hepatic,  in  the  formation  of  which  the  left 
pneumogastric  nerve  participates,  having  special  charge  of  the 
liver  activities.  Its  branches  ramify  throughout  the  liver  upon 
the  branches  of  the  portal  vein  and  the  hepatic  artery,  the  chief 
supply  being  to  the  latter.  The  blood-supply  from  both  of 
these  sources  is  thought  to  be  essential  to  the  activities  of  the 
liver  cells.  The  nutrient  blood-sulpy  (hepatic)  is  chiefly  gov- 
erned by  branches  of  the  sympathetic.  A  cystic  plexus  of  the 
sympathetic  supply  is  spread  upon  the  gall-bladder  and  bile- 
ducts.  The  American  Text-Book  of  Physiology  states  that 
special  investigation  has  shown  that  these  nerves  are  similar  in 
function  to  vaso-constrictor  and  vaso-dilator  nerves,  and  that 
stimulation  of  the  peripheral  end  of  the  cut  splanchnics  causes  a 
contraction  of  the  bile-ducts  and  gall-bladder,  while  stimulation 
of  the  cut  end  of  the  same  nerve  causes  reflex  dilatation.  Ac- 
cording to  the  same  investigator,  stimulation  of  the  central  end 
of  the  vagus  nerve  causes  contraction  of  the  gall-bladder  and  at 
the  same  time  an  inhibition  of  the  sphincter  muscle  closing  the 
opening  of  the  common  bile-duct  into  the  duodenum. 

These  interesting  and  instructive  facts  cannot  but  be  of 
much  significance  to  the  Osteopath.  Doubtless  he  could  not 
avail  himself  of  these  detailed  facts  to  manipulate  at  will  the 
activities  of  the  biliary  apparatus,  but  spinal  and  other  lesions 
affecting  the  sympathetic  connections  of  the  organs  must  be 
efficient  causes  in  producing  abnormal  function. 

Osier  states  that  any  cause,  such  as  tight  lacing,  bending 
forward  at  a  desk,  enteroptosis,  etc.,  which  produces  stagnation 
of  bile  favors  cholelithiasis.  From  an  osteopathic  standpoint, 
and  in  view  of  the  above  facts,  it  is  a  reasonable  conclusion  that 
certain"  spinal  lesion,  acting  through  this  nerve-mechanism  above 
described,  may  cause  a  stimulated,  irritated,  or  over-active  con- 
dition of  the  dilator  fibers  of  the  ducts  and  gall-bladder,  thus 
maintaining  a  permanent  dilated  or  sluggish  condition  of  the 
apparatus,  favoring  stagnation  of  the  bile  and  the  formation  of 
gall-stones.  Likewise  one  must  concede  the  possibility  of  le- 
sion to  the  central  end  of  the  vagus  nerve,  cutting  off  the  normal 

13 


194  PRACTICE    OF   OSTEOPATHY. 

impulses  through  the  nerve  which  contract  the  gall-bladder  and 
relax  the  sphincter  of  the  common  duct,  thus  allowing  of  a  lack 
of  normal  contraction  of  the  bladder  and  opening  of  the  duct; 
in  other  words,  favoring  a  sluggish  condition  of  the  biliary  ap- 
paratus leading  to  retention  and  stagnation  of  bile,  thus  to  chole- 
lithiasis. If  any  osteopathic  spinal  lesion  can  interfere  with 
sympathetic  visceral  supply,  a  point  placed  beyond  controversy 
by  demonstrated  facts,  it  is  a  reasonable  conclusion  that  spinal 
lesion  to  the  sympathetic  supply  to  the  liver  can  become  the 
cause  of  gall-stones  in  this  way. 

According  to  the  catarrhal  theory  of  the  formation  of  gall- 
stones, lithogenous  catarrh  of  the  mucosa  of  the  bladder  and  duct 
modifies  the  chemical  constitution  of  bile  and  favors  the  deposit- 
ion of  cholesterin  about  some  nucleus,  such  as  epithelial  debris. 
Cholesterin  and  lime  salts  are  produced  by  the  inflamed  mucous 
membrane  to  form  the  calculus.  As  shown  above,  both  the 
hepatic  and  portal  blood-supply  is  under  control  of  the  hepati- 
plexus,  i.  e.,  of  the  solar  plexus  and  the  splanchnics.  According 
to  the  American  Text-book  of  Physiology,  stimulation  or  inhibi- 
tion (section)  of  tfye  splanchnics  produces  at  once  vaso-constric- 
tion  or  vaso-dilatation  of  the  blood-vessels  of  the  liver.  Here, 
as  in  the  case  of  gastric  or  intestinal  catarrh,  spinal  lesion  to  the 
splanchnics  could  disturb  vaso-motor  equilibrium  in  the  liver  and 
cause  catarrh  of  the  mucous  membrane. 

It  is  the  practice  of  Osteopaths  to  give  close  attention  to 
the  condition  of  the  spleen  in  case  of  gall-stones.  Important 
lesions  to  this  organ  are  often  found  in  such  cases  (8th  to  12th 
left  ribs,  A.  T.  Still).  Removal  of  this  lesion  seems  to  prevent 
further  formation  of  the  calculi.  What  influence  the  spleen 
naturally  exerts  upon  the  liver  is  not  known.  The  splenic  and 
superior  mesenteric  veins  unite  to  form  the  portal  vein.  The 
abundant  venous  flow  from  the  spleen  is  carried  directly  to  the 
liver  in  the  portal  circulation.  The  American  Text-Book  shows 
that  there  is  little  doubt  that  the  materials  actually  utilized  by 
the  liver  cells  in  forming  their  secretions  are  brought  to  them 
mainly  by  the  portal  vein.  The  blood  which  has  circulated 
through  the  spleen  must  compose  an  important  part  of  the  blood 
brought  by  the  portal  vein  to  the  liver.  It  may  bo  that  certain 


PRACTICE    OF   OSTEOPATHY.  195 

products  of  splenic  activity  are  useful  in  maintaining  the  fluidity 
of  the  cholesterin  and  in  preventing  the  formation  of  gall-stones. 
The  spleen  is  enlarged  and  tender  in  this  case. 

Sensory  nerves  pass  through  the  sympathetic  from  the 
(6th?)  7th,  8th,  9th  and  10th  spinal  nerves  (Quain).  This  fact 
may  explain  the  radiation  of  the  pain  in  hepatic  colic  to  the  spine 
and  right  shoulder,  and  forms 'a  good  anatomical  reason  why  in- 
hibition over  this  spinal  region  will  aid  in  stopping  the  pain. 

The  PROGNOSIS  is  good,  even  in  serious  cases  in  which  opera- 
tion has  seemed  advisable.  The  case  is  frequently  presented  to 
the  Osteopath  as  the  last  resort  before  operation,  and  results 
have  been  almost  uniformly  good. 

TREATMENT:  The  success  of  the  treatment  seems  to  rest 
mainly  upon  the  mechanical  effect  and  upon  the  relaxation  of 
all  tissues  concerned,  gall-ducts  included,  gained  by  the  use  of 
osteopathic  methods.  The  main  treatment  in  these  cases  is 
locally  about  the  region  of  the  liver;  as  much  of  the  relaxing  and 
inhibitive  treatment,  and  the  main  work  of  removing  the  stone 
are  done  here.  Spinal  work  is  important,  as  here  inhibition  for 
the  pain  of  the  colic  is  made,  lesion  is  corrected,  and  circulation 
is  stimulated.  Nervous  control  is  an  important  factor  in  the 
treatment.  It  is  gained  by  both  spinal  and  abdominal  work, 
perhaps  alone  by  the  removal  of  lesion. 

The  objects  of  the  treatment  are:  (1)  To  remove  the  stone, 
(2)  To  restore  normal  liver  function  and  prevent  further  forma- 
tion of  stones. 

The  former  is  palliative  treatment;  the  latter  is  the  real  cure. 

In  the  acute  case,  if  colic  is  present  the  first  step  is  to  make 
strong  inhibition  over  the  7th  to  10th  spinal  nerves.  (Some 
say  upon  the  right  side).  This  will  lessen  or  stop  the  pain,  and 
allow  of  work  upon  the  abdomen.  This  is  deep,  relaxing  inhi- 
bitive work  upon  the  tensed  abdominal  walls,  over  the  epigastric 
and  lower  anterior  thoracic  regions,  and  over  the  course  of  the 
duct  (IX,  Chap.  VIII).  The  pain,  which  is  due  to  inflammation 
of  the  mucosa  of  the  duct  and  to  the  rotary  motion  of  the  stone, 
which  is  given  this  motion  by  the  spiral  arrangement  of  the 
Heisterian  valve  within  the  duct,  is  usually  relieved  in  a  few 
minutes. 


196  PRACTICE    OF    OSTEOPATHY. 

The  stone  is  removed  by  working  it  along  the  duct  after  the 
preliminary  relaxing  treatment.  The  patient  should  lie  upon 
his  back  with  knees  flexed  and  shoulders  slightly  raised.  The 
lower  ribs  are  raised  by  inserting  the  fingers  beneath  their  an- 
terior edges,  and  manipulation  is  made  deeply  over  the  site  of  the 
fundus  of  the  gall-bladder  (tip  of  9th  rib)  and  down  along  the 
course  of  the  duct.  The  latter  may  vary  from  its  course  on  ac- 
count of  sagging  of  the  intestines  sometimes  found.  This  treat- 
ment must  be  thorough  and  persistent.  It  should  be  firmly  and 
deeply,  but  most  carefully  applied.  Sometimes  a  few  minutes 
work  will  pass  the  stone,  but  often  continued  treatment  for  three- 
quarters  of  an  hour  or  an  hour  be  devoted  to  it.  Only  careful 
manipulation  could  be  borne  by  the  patient  for  this  length  of 
time.  As  long  as  the  stone  remains  in  the  duct  and  causes  the 
colic  the  attempt  to  remove  it  should  be  continued,  though  it 
may  not  be  advisable  to  treat  continuously  all  of  the  time.  The 
stone  may  or  may  not  be  large  enough  to  be  felt  in  the  duct. 
Stones  are  often  passed  without  pain.  Some  stones  are  soft  and 
may  be  carefully  broken  down  by  the  treatment. 

The  spleen  is  treated  by  careful  abdominal  work  over  and 
beneath  the  lower  left  ribs,  anteriorly.  It  is  chiefly  affected  by 
treatment  to  the  splanchnics,  raising  the  lower  left  ribs  (8th  to 
12th),  and  removal  of  lower  spinal  and  rib  lesion. 

The  jaundice,  if  intense,  indicates  impaction  of  the  stone 
in  the  common  duct.  Its  cure  depends  upon  the  removal  of 
the  stone.  The  kidneys  should  be  kept  active. 

Fever,  if  present,  is  allayed  in  the  usual  manner.  Fatal 
syncope  sometimes  occurs.  If  imminent,  the  patient  should  be 
fortified  against  it  by  thorough  stimulation  of  the  heart.  For 
obstruction  of  bowel  by  calculi,  see  Intestinal  Obstruction. 

A  dilated  gall-bladder  and  duct  are  treated  locally  by  manip- 
ulation to  remove  the  obstruction  as  for  removal  of  the  stone. 
Thorough  treatment  must  be  given  the  liver  locally,  and  thor- 
ough spinal  treatment  must  be  kept  up  for  the  puqiose  of  in- 
creasing circulation,  etc. 

According  to  Dr.  A.  T.  Still  the  lesion  of  the  6th  to  10th  left 
ribs,  found  in  cases  of  gall-stones,  is  obstructing  pancreatic  se- 
cretions. These,  he  says,  dissolve  gall-stones.  They  are  ab- 


PRACTICE    OF    OSTEOPATHY.  197 

sorbed  from  the  intestines  by  the  lacteals  and  carried  by  them 
into  the  portal  circulation,  and  thus  to  the  liver  as  portal  blood, 
where  they  may  influence  the  secretion  of  bile,  and,  mingling 
with  the  latter  as  a  constituent  of  the  bile,  act  upon  stones  already 
formed.  The  patient  should  drink  plenty  of  alkaline  waters. 

SUPPURATIVE  CHOLANGITIS. 

This  is  a  suppurative  process  in  the  mucous  membrane 
lining  the  duct,  and  is  commonly  the  result  of  gall-stones.  It 
may  be  due  to  parasites,  or  may  arise  after  typhoid  fever,  dysen- 
tery, or  other  acute  disease. 

The  treatment  is  upon  the  lines  laid  down  for  the  treatment 
of  the  liver,  gall-stones,  etc.  The  local  circulation  must  be  kept 
free  to  overcome  the  suppuration  and  to  repair  the  membranes. 
This,  with  treatment  along  the  course  of  the  duct  opens  it,  and 
lets  free  the  flow  of  bile. 

DISEASES  OF  THE  LIVER— CONTINUED. 

CASES:  (1)  Hepatic  abscess,  complicated  with  gastric  ulcer. 
Lesions  at  the  3rd  cervical,  and  at  the  4th,  5th,  and  8th  dorsal; 
rigid  spinal  muscles;  7th  to  10th  right  ribs  over-lapped.  The 
case  was  in  a  very  serious  condition,  but  began  to  improve  after 
two  weeks,  and  was  finally  cured  by  the  treatment.  (2)  Torpid 
liver,  with  chronic  gastritis;  marked  lesion  at  4th  and  5th  dorsal; 
slight  lesion  at  the  9th  dorsal  , 

For  HEPATIC  AIJSCESS  the  prognosis  must  be  guarded  and 
unfavorable.  While  limited  quantities  of  pus  may  be  effectually 
and  safely  absorbed  through  increased  circulation,  any  large 
quantity  could  probably  not  be  thus  disposed  of.  Some  cases 
have  been  cured  by  osteopathic  treatment,  and  there  are  some 
chances  of  curing  the  ordinary  case  presented  for  treatment. 
The  fact  that  the  disease  has  and  can  be  cured  warrants  thor- 
ough trial. 

The  TREATMENT  must  be  to  absorb  the  pus  and  heal  the 
ulcer  through  increased  circulation  of  the  blood.  Removal  of 
lesion  is  naturally  the  important  step  in  this  process,  as  it  is  ob- 
structing proper  circulation  and  innervation.  The  usual  lesions 
in  liver  diseases  must  be  expected.  Full  directions  have  been 
given  for  treatment  of  circulation  to  the  liver.  Great  care  must 


198  PRACTICE    OF    OSTEOPATHY. 

be  taken  in  local  treatment  over  the  liver  because  of  danger  of 
rupturing  the  abscess.  Pain,  if  present,  is  quieted  as  before. 
Attention  must  be  given  to  the  gastro-intestinal  disorders,  con- 
stipation and  diarrhoea.  As  abscess  is  frequently  secondary  to 
some  other  disease,  treatment  must  be  made  accordingly  in  such 
cases.  A  bronchial  cough,  frequently  present,  may  be  guarded 
against  by  stimulation  of  the  vaso-motors  to  the  lungs. 

HYPERTROPHY  OF  THE  LIVER  is  frequently  presented  for 
treatment,  and  as  a  rule  good  results  are  gotten.  Many  cases 
are  cured.  Complete  restoration  of  size  and  function  often  re- 
sults from  the  treatment.  In  many  other  cases,  while  the  size 
cannot  be  reduced  to  normal  limits,  functions  is  restored.  The 
general  prognosis  is  favorable.  In  true  hypertrophy  due  to  in- 
crease of  connective  tissue  the  new  tissue  can  probably  not  be 
absorbed,  but  the  further  increase  of  it  may  be  checked  and  the 
function  is  usually  restored. 

In  true  hypertrophy  due  to  increase  in  size  or  number  of  the 
parenchymatous  cells,  the  treatment  may  reduce  their  size  or 
number,  and  normal  size  and  function  of  the  liver  is  restored.  As 
the  chief  causes  of  hypertrophy  are  active  and  passive  conges- 
tion (lesion  to  the4  vaso-motors,)  good  results  follow  corrected 
circulation. 

In  false  hypertrophy  due  to  cancer  or  abscess  little  is  ex- 
pected in  the  way  of  reudction.  When  due  to  fatty  infiltration, 
the  renewed  circulation  removes  the  accumulated  fatty  particles 
and  restores  normal  size  and  function.  In  these  cases  diet  is 
very  important.  Avoid  fats,  starches,  and  wheat  bread.  Use 
gluten  or  bran  bread,  also  fish,  lean  meat,  vegetables  and  fruit, 
but  no  alcohol.  Exercise  and  baths  should  be  employed.  The 
treatment  in  these  cases  consists  in  the  removal  of  lesion  and  cor- 
rection and  stimulation  of  circulation.  The  prognosis  is  good. 
The  size  of  the  liver  can  be  reduced  to  normal.  When  secondary, 
the  primary  disease  is  treated. 

In  fatty  degeneration  of  the  liver  good  results  may  be  expected 
from  the  treatment.  It  consists  simply  in  the  removal  of  lesion 
and  in  the  active  stimulation  of  the  circulation,  with  due  atten- 
tion to  the  primary  condition  upon  which  the  degeneration  de- 
pends. Diet,  exercise  and  baths  should  be  used  as  in  the  treat- 


PRACTICE  OF    OSTEOPATHY.  199 

rnent  of  fatty  infiltration.  Recorded  facts  are  lacking  in  regard 
to  cancer  and  acute  yellow  atrophy,  of  the  liver.  The  latter  two 
are  rare  conditions,  yellow  atrophy  exceedingly  so.  Treatment 
for  these  diseases  could  be  worked  out  according  to  the  fates 
and  principles  given  in  relation  to  the  various  diseases  of  the 
liver  already  discussed. 

In  AMYLOID  INFILTRATION  of  the  liver  the  starch-like  de- 
posit occurring  in  the  connective  tissues  of  the  liver  must  be 
absorbed  in  the  renewed  blood-supply.  But  the  condition  of 
the  blood  is  an  impoitant  factor,  apparently,  as  it  is  thought  that 
in  suppurative  processes  in  the  body,  to  which  the  disease  is  fre- 
quently due,  the  alkalinity  of  the  fluids  of  the  body  has  been 
decreased.  The  general  health  must  be  built  up,  the  excretion 
stimulated,  and  the  blood  purified.  The  primary  disease,  such 
as  tuberculosis,  rickets,  etc.,  must  be  attended  to.  Any  local 
lesions  must  be  repaired,  and  the  circulation  be  kept  stimulated. 
A  thorough  general  course  of  treatment  is  necessary.  The  diet 
should  be  carefully  attended  to,  It  should  consist  of  nitrogenous 
or  animal  food.  Starches  and  fats  should  be  avoided.  Lean 
meats  and  green  vegetables,  etc.,  are  allowed.  Exercise  and 
bathing  should  be  encouraged. 

SPLENITIS. 

DEFINITION:  Acute  or  chronic  proliferative  inflammation 
of  the  spleen.  Suppuration  may  occur. 

CASES:  (1)  Lady,  fifty  years  of  age,  suffering  from  chronic 
inflammation  of  the  spleen.  Spleen  was  much  enlarged,  and 
she  was  unable  to  wear  corsets.  Lesion  was  found  in  the  form 
of  a  misplaced  rib  pressing  upon  the  spleen.  Its  replacement 
caused  the  pain  to  disappear,  and  the  waist  measured  two  inches 
less  the  next  morning.  (2)  Splenitis;  the  case  showing  lesion  as 
depression  of  the  9th,  10th,  and  llth  left  ribs,  and  a  posterior 
swerve  of  the  lower  dorsal  and  lumbar  region. 

LESIONS  occur  in  downward  and  forward  luxations  of  the 
6th  to  12th  left  ribs.  (A.  T.  Still).  Diaphragmatic  lesion  thus 
caused  may  interfere  with  position,  circulation,  or  innervation 
of  the  organ.  Direct  pressure  of  a  misplaced  rib,  or  lower  splanch- 
nic lesion  causing  interference  with  spinal  innervation,  may 
cause  the  trouble. 


200  PRACTICE  OF  OSTEOPATHY. 

ANATOMICAL  RELATIONS:  Stimulation  of  the  peripheral 
end  of  the  splanchnic  causes  sudden  and  large  diminution  of  the 
volume  of  the  spleen.  It  is  probable  that  this  diminution  is  due 
to  contraction  of  its  trabeculae  and  capsule,  which  are  plentifully 
supplied  with  involuntary  muscle  fibers.  "The  organ  is  richly 
supplied  with  nerve, fibers  which,  when  stimulated  directly  or 
reflexly,  cause  the  organ  to  diminish  in  volume"  (American  Text- 
Book  of  Physiology).  According  to  Schafer,  these  are  contained 
in  the  splanchnics,  which  carry  also  inhibitor}'  fibers  whose  stim- 
ulation causes  dilatation  of  the  spleen. 

In  view  of  these  facts  it  seems  that  treatment  over  the  splanch- 
nic area  of  the  spine  and  locally  over  the  spleen  may  produce 
change  in  its  volume  (through  thus  directly  or  indirectly  stim- 
ulating these  nerve  connections)  which  is  most  useful  in  correct- 
ing circulation  through  it.  In  addition  to  this,  the  same  work 
would  affect  the  vaso-motor  mechanism  of  the  organ.  The 
splenic  plexus,  ramifying  upon  the  splenic  artery,  is  composed 
of  sympathetic  fibers  from  the  solar  plexus  and  of  branches 
from  the  right  pneumogastric.  Local  or  spinal  treatment  affect 
these.  It  is  readily  'apparant,  in  view  of  the  whole  mechanism 
described  above,  that  spinal  and  rib  lesion  may  seriously  affect 
the  organ  by  disturbance  of  these  nerve  connections,  producing 
inflammatory  or  congestive  conditions. 

Anders  states  that  splenitis  is  probably  never  primary,  but 
in  case  (1)  cited  above  it  seems  that  the  disease  must  have  origi- 
nated primarily  in  the  spleen  by  action  of  the  disturbance  caused 
by  the  displaced  rib. 

TREATMENT:  As  splenitis  and  congestion  are  frequently 
secondary  to  some  other  disease  (malaria,  typhoid,  etc),  such 
diseases  must  be  treated  primarily.  Removal  of  lesion,  as  in 
the  above  case,  may  be  the  only  treatment  necessary.  Stim- 
ulation or  inhibition  of  the  splanchnics  at  the  spine,  and  of  the 
capsule  and  local  plexuses  by  work  directly  upon  the  organ,  is 
made.  Care  must  be  taken  in  the  latter  process  to  avoid  danger 
of  rupture  of  the  organ. 

Inhibitive  work  upon  the  splanchnics.  the  solar  plexus, 
and  the  abdomen  will  dilate  the  abdominal  vessels  and  draw 
the  blood  to  them,  away  from  the  spleen. 


PRACTICE    OF    OSTEOPATHY.  201 

SPLENIC  HYPER.EMIA,  active  or  passive,  is  readily  reduced. 
Chronic  cases  may  yield  at  once  or  may  require  a  patient  course 
of  treatment.  Contraction  of  the  tissues  about  the  splenic  vein 
has  been  known  to  cause  great  enlargement  of  the  organ  by  pas- 
sive congestion.  Upon  removal  of  the  obstruction  the  organ 
quickly  returned  to  its  normal  limits.  The  lesions  and  treat- 
ment are  the  same  as  indicated  for  splenitis. 

DISEASES  OF  THE  PANCREAS. 

The  lesions  commonly  found  affecting  the  pancreas  are 
those  occurring  at  the  lower  ribs  and  to  the  lower  dorsal  verte- 
brse.  Generally  the  diseases  of  this  organ  are  complications  of, 
or  secondary  to,  other  diseases,  most  frequently  those  of  the 
Castro-intestinal  tract.  As  the  blood  and  nerve-sulppy  of  these 
parts  are  closely  related,  it  is  not  strange  that  the  lesions  affect- 
Ing  this  tract  should  also  often  be  the  cause  of  derangement  of 
the  pancreas.  The  blood  and  nerve-supply  are  especially  closely 
related  to  that  of  the  liver,  stomach  and  spleen.  The  nerves  are 
from  the  splenic  plexus,  which  is  derived  from  the  right  and  left 
semilunar  ganglia  and  from  the  right  pneumogastric.  The  pan- 
creatic plexus  thus  formed  is  closely  connected  with  the  hepatic 
plexus  and  with  the  left  gastro-epiploic  plexus.  These  are  all 
offsets  of  the  coeliac  plexus.  The  arterial  supply  is  from  the 
superior  mesenteric,  and  from  the  coeliac  axis  by  way  of  the  hepatic 
and  splenic  arteries.  The  venous  drainage  is  into  the  splenic  and 
superior  mesenteric  veins,  thus  directly  into  the  portal  system. 

Thus  it  may  be  seen  at  a  glance  how  the  inter-relation  of 
these  anatomical  parts  lays  the  pancreas  liable  to  the  action  of 
those  lower  dorsal  lesions  that  cause  disease  in  the  stomach, 
liver,  intestines,  spleen,  etc. 

Treatment  to  the  spinal  nerve-connections  in  the  region 
mentioned,  and  to  these  plexuses  directly  by  work  in  the  ab- 
dominal region  over  them,  affects  the  pancreas.  Local  or  direct 
treatment  is  given  it  by  deep  manipulation  in  the  median  plane 
of  the  abdomen,  midway  between  the  ensiform  and  the  umbilicus. 
Abdominal  treatment  may  also  mechanically  affect  its  blood- 
vessels; and  may  remove  obstruction  from  them,  from  the  duct, 
or  from  the  organ  itself,  when  caused  by  growths  in  the  abdomen, 


202  PRACTICE    OF    OSTEOPATHY. 

malposition  of  the  contiguous  organs,  etc.     Local  treatment  over 
the  pancreas  should  be  done  when  the  stomach  is  empty. 

ACUTE  PANCREATITIS,  hemorrhagic,  suppurative,  or  gan- 
grenous, is  generally  due  to  gastro-intestinal  disorders,  such  as 
dyspepsia,  glycosuria,  gall-stones,  catarrhal  inflammation  etc. 
Doubtless  the  lesion  responsible  for  the  primary  disease  is  di- 
rectly accountable  for  the  effect  upon  the  pancreas,  the  same 
lesion  deranging  the  nerve  and  blood-supply  of,  each  diseased 
part. 

Traumatism  may  directly  affect  the  substance  of  the  gland, 
or  it  may  cause  various  lesions  to  nerves  and  vessels,  and  pro- 
duce either  form  of  pancreatitis.  The  disease  is  often  secondary 
to  tuberculosis,  specific  fevers,  etc. 

The  treatment  must  depend  to  some  extent  upon  the  cause. 
In  any  case  it  is  necessary  to  remove  the  lesion,  and  to  take 
down  the  inflammation  by  removing  all  sources  of  irritation  or 
obstruction  to  the  circulation.  Treatment  may  be  made  along 
the  course  of  the  venous  drainage  as  above  pointed  out.  The 
left  lower  ribs  should  be  elevated,  and  the  lower  dorsal  spine  re- 
laxed. Local  treatment  over  the  organ  must  be  carefully  ap- 
plied. The  pain  should  be  treated  by  strong  spinal  inhibition 
and  by  relaxation  of  the  upper  abdominal  tissues.  The  nausea, 
vomiting,  hiccough,  constipation,  diarrhoea,  etc.,  may  all  be 
treated  as  before  directed. 

Every  effort  should  be  made  to  alleviate  the  patient's  suf- 
fering. 

Mild  cases  of  hemorrhagic  pancreatitis  may  recover;  the  other 
forms  are  fatal. 

Chronic  pancreatitis  is  to  be  treated  upon  the  same  plan. 

Treatment  for  for  otherms  of  pancreatic  disease  could  be 
worked  out  according  to  general  points  given  above. 

DISEASES  OF  THE  URINARY  SYSTEM. 

CASES:  (1)  Lithuria  in  a  young  girl  after  typho-malaria. 
Lesion,  a  faulty  condition  of  the  lower  dorsal  and  lumbar  re- 
gions. Such  quantities  of  uric  acid  "sand"  appeared  as  to  be 
easily  seen  by  the  naked  eye.  Dr.  A.  T.  Still  found  a  "hot  spot" 
at  the  4th  lumbar  which  was  slipped.  Also  found  the  10th  right 


PRACTICE    OF    OSTEOPATHY.  203 

rib  off  its  articulation  at  its  head,  interfering  with  the  function 
of  the  adrenal  bodies.  In  less  than  two  hours  after  his  treatment 
normal  urine  was  passed.  The  previous  passage,  one-half  hour 
before  the  treatment,  had  been  cloudy,  dark,  and  contained  a 
heavy  precipitate. 

(2)  Abscess  of  the  kidney  and  catarrh  of  the  bladder,  (chronic 
cystitis)  of  three  years  standing,  in  a  man.     He  was  obliged  to 
urinate  ever  five  or  ten  minutes,  always  with  great  pain.     The 
urine  was  about  one-half  sediment  and  blood,  and  only  about  one- 
half  the  normal  amount.     After  six  weeks  treatment  the  case 
was  almost  well,  no  pain  upon  urination;  retains  urine  one  hour; 
practically  no  sediment;  normal  amount  of  urine. 

(3)  B  right's  disease  in   a   man   twenty-nine  years   of   age* 
diagnosis  confirmed  by  several  physicians;  great  dropsical  swell- 
ing of  feet,  limbs  and  body  up  to  the  12th  dorsal  vertebra.     After 
five  weeks  treatment  he,  was  able  to  go  to  work  at  an  occupation 
that  kept  him  constantly  upon  his  feet.     After  the  fourth  treat- 
ment there  had  been  rapid  improvement;  in  six  weeks  the  urine 
was  almost  normal,  and  the  dropsy  had  disappeared. 

(4)  Acute  nephritis  in  a  married  woman  of  65,  of  4  weeks 
standing.     She   had   suffered   from   previous   attacks.     The   in- 
flammation had  extended  to  ureters  and  bladder  (cystits).  10th, 
llth,  and  12th  dorsal  were  posterior  and  lateral.     The  case  was 
cured  in  3  weeks.     It  was  free  of  pain  after  the  second  day. 

(5)  Acute  Nephritis  in  a  man  of  forty.     Lesion  was  found 
irritating  the  renal  splanchnics.     The  treatment  was  at  the  llth 
and  12th  dorsal,  and  raising  of  the  llth  and  12th  ribs. 

(6)  Acute   Bright 's  disease.     Large   quantities   of  albumen 
appeared  in  the  urine.     The  12th  dorsal  vertebra  was  found  an- 
terior.    One  treatment  relieved  the  pain  and  the  patient  slept. 
Good  progress  was  reported. 

(7)  Acute  Bright 's  disease.     Spinal  lesion  was  found.     After 
seven  weeks  treatment  no  further  symptoms  remained.     For  five 
weeks  a  physician  examined  the  urine  daily  finding  no  further 
evidence  of  the  trouble  at  the  end  of  that  time.     He  said  he  had 
never  seen  a  case  do  so  well. 

(8)  Bright 's  disease  and  paraplegia;  lesion  was  found  as  a 
separation  between  the  llth  and  12th  dorsal.     There  was  a  his- 


204  PRACTICE    OF    OSTEOPATHY. 

tory  of  the  patient's  having  jumped  from  moving  trains  for  years. 

(9)  Chronic    Nephritis     (probably)     diagnosed    as    floating 
kidney.     The  patient,  a  lady  of  twenty-five,  was  in  a  very  bad 
condition;   heavy   sediment   in   the   urine;   painful   micturition. 
Lesions:     Upper  cervical  lateral;  posterior  curvature  from  5th 
dorsal  to  5th  lumbar;  marked  lesion  at  10th,  llth,  and  12th  dor- 
sal, and  2nd  lumbar.     The  llth  and  12th  ribs  were  subluxated, 
giving  the  appearance  of  tumor,  diagnosed  as  floating  kidney. 
The  case  began  to  improve  upon  the  first  treatment,  and  was 
practically  cured  in  two  months. 

(10)  Enuresis  in  a  boy  of  seventeen,  of  seven  years  standing. 
Occipital    pains    present.     Tissues    about    2nd    cervical    tense; 
about  3rd  and  4th  cervical  sore;  7th  and  8th  dorsal  vertebrae  an- 
terior and  sore.     The  boy  had  been  thrown  from  a  horse  at  ten 
years  of  age,  and  the  trouble  had  persisted  ever  since. 

(11)  Enuresis.     The  5th  lumbar  vertebra  was  lateral.     The 
<?ase  was  entirely  cured  in  six  weeks  by  the  removal  of  this  lesion. 

(12)  Enuresis  in  a  boy  of  five.     The  lumbar  region  was  very 
weak,  and  had  a  posterior  tendency.     Treatment  here  relieved 
the  case. 

(13)  Enuresis  in  a  boy  of  five,  had  been  present  all  his  life. 
For  four  years  he  had  been  constantly  under  medical  care.     He 
had  no  warning  of  the  passage  of  urine,  even  in  the  day  time. 
After  eleven  treatments  but  two  involuntary  passages  occurred 
in  eight  months.     After  a  recurrence  due  to.  an  attack  of  the 
mumps,  two  weeks  treatment  cured  the  case.     The  treatment 
was  given  over  the  sacral  and  lumbar  regions. 

(14)  Enuresis  in  a  boy  of  nine.     He  had  been  so  troubled 
for  eight  years  during  sleep.     The  usual  methods  of  treatment 
had  been  without  avail.     Great  tenderness  and  a  slight  lesion 
occurred  at  the  2nd  lumbar,  removal  of  which  cured  the  case. 

(15)  Enuresis  in  a  boy  of  twelve  who  had  always  had  poor 
health.     For  eight  years  nocturnal  urination  had  been  constantly 
present.     In  the  day  time  the  urine  passed  involuntarily.     Le- 
sions were  found  in  the  cervical  region;  pronounced  posterior 
position  of  the  lower  dorsal  spine;  lesions  from  the  2nd  to  5th 
lumbar.     Steady    improvement    took    place    under    treatment, 
and  the  case  was  cured  in  three  months. 


PRACTICE  OF  OSTEOPATHY.  205 

(10)  In  a  man  of  21,  enuresis  and  chronic^eystitis,  of  five 
years  standing.  Voiding  of  urnie  was  usually  followed  by  the 
passage  of  pus  and  blood.  There  were  accompanying  pains 
through  penis  and  bladder.  The  8th  dorsal  to  2nd  lumbar  ver- 
tebrae were  posterior,  the  left  innominate  was  forward  and  down- 
ward, the  pros.tate  gland  was  enlarged.  The  case  was  improving 
under  treatment. 

(17)  Renal  Calculus.     Lesion  was  found  in  the  llth  dorsal. 
Inhibiting  treatment  upon  the  renal  splanchnic  lessened  pain. 
The  calculus  was  worked  along  the  course  of  the  ureter  ftito  the 
bladder  and  passed  later. 

(18)  Renal  Calculi,  in  which  operation  had  been  advised. 
The  patient  was  kept  in  bed  by  the  great  pain  of  the  colic.     After 
two  treatments  the  patient  was  able  to  go  to  the  office  for  treat- 
ment, and  after  a  third  treatment  had  no  further  trouble. 

(19)  Renal  Calculi.     There  was  great  pain  due  to  the  colic, 
which  was  lessened  by  inhibition  of  the  renal  splanchnics.     Le- 
sion was  found  at  the  llth  dorsal.     The  stone  was  manipulated 
down  along  the  ureter,  the  pain  moving  downward  with  it.     Twelve 
hours  later  the  calculus  passed  from  the  bladder. 

(20)  Uremic   Poisoning;   the   case   was   sleepless,   vomiting, 
and  near  convulsions.     Treatment  relieved  the  case  at  once. 

(21)  Uremic    poisoning    (kidney    and    bladder    disease)    in 
which  the  patient  was  in  a  critical  condition;  had  not  slept  for 
two  days  on  account  of  severe  pain.     The  pain  was  relieved  by 
the  treatment.     Spinal  lesion  was  found  at  the  centers  for  bladder 
and  kidneys.     Great  improvement  attended  one  months  treat- 
ment. 

(22)  Retention  of  urine  from  enlarged  prostate,  and  uric 
acid  poisoning,  in  a  man  of  seventy-three  years  of  age.     He  was 
about  to  be  operated  upon  for  "abdominal  tumor."     The  Osteo- 
path used  a  catheter  at  once,  and  drew  about  a  gallon-  of  decom- 
posing urine.     The  next  morning  about  one  quart  of  urine  was 
drawn,  containing  much  blood  and  stringy  mucous.     In  three 
months  treatment  the  prostate  was  reduced,  and  the  urination 
was  about  normal. 

(23)  Inflammation    of    the    urinary    meatus.     Constipation 
was  present.     There  had  been  congestion  of  the  kidneys  one  year 


206  PRACTICE   OF    OSTEOPATHY. 

before.  The  vertebrae  from  the  2nd  to  the  5th  dorsal  were  ap- 
proximated and  to  the  right;  those  from  the  8th  dorsal  to  3rd 
lumbar  were  separated.  The  right  innominate  was  -displaced 
upward  and  backward,  shortening  the  limb. 

(24)  A  kidney  trouble  of  five  years  standing,  complicated 
with  heart  disease,  due  to  lesions  as  follows:     A. luxated  atlas, 
causing  the  heart  difficulty,  which  was  cured  by  righting  the 
atlas;  9th  dorsal  vertebras  posterior;  2nd  lumbar  lateral;  5th  lum- 
bar anterior.     The  case  was  cured  in  three  months. 

(25)  Kidney  disease  due  to  double  scoliosis,  6th  to   10th 
dorsal  left;  1st  to  5th  lumbar  posterior.     Treatment  of  the  curva- 
ture improved  the  kidneys. 

(26)  Frequent  micturition,  varicocele  and  weak  eyes  being 
present.     The  lesions  were  at  the  3rd  cervical,  lateral  spinal  cur- 
vature, and  lesion  at  the  2nd  and  4th  lumbar. 

(27)  Pyuria.     See  case  (16). 

(28)  Hematuria.     See  case  (16) 

(29)  A  case  of  kidney  disease  is  reported  in  which  insuffici- 
ency of  urine  was  overcome  solely  by  stimulation  of  the  superior 
cervical  ganglion.     A  renal  center  exists  in  the  medulla,  and  was 
thus  affected.     The  quantity  of  urine  was  trebled  by  the  treat- 
ment.    No  other  treatment  was  given.     Probably  the  general 
vaso-motor  center  in  the  medulla,  through  the  treatment  of  the 
superior  cervical  ganglion,  supplied  the  increased  blood-pressure 
and  the  arterial  tension  in  the  kidneys  necessary,  under  the  cir- 
cumstances, to  activity  of  the  organ. 

LESIONS:  The  centers  of  importance,  osteopathically,  in 
urinary  diseases  are  generally  stated  as  follows:  6th  dorsal  for 
kidneys;  12th  dorsal  for  renal  splanchnics;  2nd  lumbar  for  mic- 
turition; 3rd  and  4th  sacral  for  neck  of  bladder;  medulla  (sup. 
cervical,  atlas)  renal  center;  2nd  to  5th  lumbar '(Am.  Text-Book 
Physiology)  urino-genital  (or  genito-spinal)  center  for  bladder; 
peritoneal  sympathetic  centers,  each  side  of  the  umbilicus  for 
the  renal  plexus;  the  umbilicus  as  a  landmark  for  the  renal  ves- 
sels and  their  sympathetic  supply,  (two  inches  above.) 

The  lesions  usually  found  in  renal  diseases  are  as  follows: 
(1)  At  the  atlas  or  upper  cervical,  affecting  the  superior  cervical 
ganglion  and  the  renal  center  in  the  medulla.  (2)  At  the  10th, 


PRACTICE    OF    OSTEOPATHY.  207 

llth  and  12th  dorsal,  and  the  1st  lumbar,  the  main  lesion  affect- 
ing the  kidneys  directly.  (3)  From  the  2nd  lumbar  to  the  4th 
sacral  for  disease  in  the  bladder  and  urethra.  (4)  In  the  female 
patient  it  may  occur  that  uterine  prolapsus,  wrinkling  the  an- 
terior vaginal  walls,  may  twist  and  obstruct  the  urethra.  (5)  In 
the  male  patient  an  enlargement  of  the  prostate  gland,  especially 
of  its  middle  lobe,  is  with  considerable  frequency  found  to  be  the 
cause,  easily  overlooked,  of  stricture  of  the  urethra. 

A  careful  analysis  of  the  lesions  in  the  cases  presented  above 
brings  out  facts  representative  of  the  class  of  cases,  (urinary  dis- 
eases). These  facts  well  illustrate  what  is  usually  found  in  such 
cases.  The  lesions  are  mostly  spinal,  few  being  rib  lesions.  As 
a  matter  of  fact,  spinal  lesions  are  the  important  causes  of  urinary 
troubles.  The  vast  nerve-supply  of  the  kidneys  and  bladder  is 
delicately  balanced.  Most  of  the  lesions  in  renal  diseases  being 
spinal,  the  conclusion  is  that  spinal  derangement  of  this  nerve- 
supply  is  the  most  potent  and  frequent  cause  of  such  disease. 
The  kidneys  are,  at  bottom,  generally  deranged  by  lesions  affect- 
ing the  nerve-supply,  including  vaso-motor,  i.  e.,  blood-supply, 
also. 

Of  these  lesions,  practically  all  are  low  down  in  the  spine, 
including  also  the  sacral  region.  Dr.  Still  points  out  sacral 
lesion  in  kidney  diseases. 

A  great  number  of  cases  show  lesion  about  the  10th,  llth 
and  12th  dorsal.  Many  show  lesion  in  the  lumbar  and  sacral 
regions.  These  latter  occur  cheifly  in  bladder  and  urethral  dis- 
eases. This  is  seen  in  the  fact  that  of  the  cases  of  enuresis  re- 
ported, most  of  them  presented  lumbar  and  sacral  lesions.  The 
fact  that  many  of  the  above  cases  showed  lesion  below  the  10th 
dorsal,  especially  about  the  10th,  llth  and  12th  dorsal,  must  be 
remarked  in  considering  distinctively  kidney  diseases'.  In  the 
cases  of  Bright's  Disease  mentioned,  all  in  which  the  lesion  was 
described  showed  lesion  in  the  lower  dorsal  and  lumbar  regions, 
practically  all  of  these  concentrating  about  the  10th  and  12th 
dorsal.  In  most  of  these  cases  the  micturition  center  at  the  2nd 
lumbar  was  affected,  participating  in  both  kidney  and  bladder 
affections.  Its  anatomical  relations  make  it  most  important  in 
the  latter  class,  and  experience  shows  that  it  is  more  likely  to 
affect  bladder  than  kidneys. 


208  PRACTICE    OF   OSTEOPATHY. 

Neck  lesions  are  not  important.  Few  of  the  caseg  show  them, 
but  they  occurred  at  the  2nd  to  4th  vertebrae,  where  they  could 
all  affect  the  superior  cervical  ganglion,  and  through  it  the  me- 
dulla. This  location  of  the  lesion  is  mainly  important  as  a  sec- 
ondary or  adjuvant  lesion  in  renal  diseases. 

Without  exception,  the  lesions  in  these  cases  fall  within 
areas  in  which  they  may  affect  the  sympathetic  innervation  of 
the  urinary  apparatus.  It  is  noticeable,  therefore,  that  only 
through  this  nerve-supply  could  they  become  the  causes  of  renal 
disease,  even  though  they  should  affect  mainly  the  blood-supply. 
The  vaso-motor  function  in  relation  to  disease  thus  has  its  im- 
portance emphasized. 

ANATOMICAL  RELATIONS:  Sensory  nerves  are  distributed 
through  the  sympathetic,  from  the  spinal  nerves,  as  follows: 
To  the  kidneys  from  the  10th,  llth  and  12th  dorsal;  to  the  upper 
part  of  the  ureter,  from  the  10th  dorsal;  at  the  lower  end  of  the 
ureter,  supply  from  the  1st  lumbar  tends  to  appear;  to  the  mucous 
membrane  and  neck  of  the  bladder,  from  the  (1st),  2nd,  3rd  and 
4th  sacral;  for  sensation  of  over-distention  and  ineffectual  con- 
traction, from  the  llth  and  12th  dorsal  and  1st  lumbar  (Quain). 
This  sensory  distribution  is  made  use  of  in  relieving  spinal  pain 
in  kidney  and  bladder-disease.  Disturbed  sensation  in  these 
parts  is  usually  found  associated  with  lesion  in  the  spinal  areas 
named,  generally  in  connection  with  more  serious  trouble. 

Vaso-motor  fibres  for  the  renal  vessel  are  found  in  the  splanch- 
nics.  and  somewhat  below,  occurring  from  the  6th  dorsal  to  the 
2nd  lumbar  nerve.  As  shown  by  the  American  Text-Book  of 
Physiology,  stimulation  of  the  central  endings,  not  only  of  the 
splanchnics,  but  also  of  the  sciatic,  causes  constriction  of  the 
renal  vessels.  Thus  work  upon  the  spine  over  the  origin  of  the 
great  sciatic  nerve,  at  the  4th  and  5th  lumbar,  and  1st,  and  3rd 
sacral,  is  useful  in  controlling  the  circulation  of  the  kidneys. 
Actual  cases  of  kidney  diseases  show  spinal  lesion  as  high  as  the 
5th  or  6th  dorsal,  and  as  low  as  the  3rd  or  4th  sacral.  The  con- 
tinual action  of  lesion  in  these  situations  upon  the  vaso-motors 
of  the  kidneys  has  most  important  pathological  results  through 
modification  of  the  renal  blood-supply.  As  a  rule  these  lesions 
are  concentrated  about  the  10th  dorsal  to  2nd  lumbar.  The 


PRACTICE  OF  OSTEOPATHY.  209 

main  vaso-motor  supply,  originating  as  above  described,  passes 
from  the  aortico- renal  ganglion,  solar  and  aortic  plexuses  to  the 
renal  plexus.  Important  branches  come  from  the  renal  splanch- 
nics,  sometimes  also  from  the  lesser  splanchnic  and  from  the  first 
lumbar  ganglion.  The  branches  of  this  plexus  lie  upon  the  renl 
vessels,  and  accompany  them  in  their  ramifications  in  the  kidneys. 
Osteopathic  work  upon  this  importantvaso-motor  supply  of  the 
kidneys,  via  the  splanchnic  area  of  the  spine(by  removal  of 
lesion)  and  the  renal  plexus,  which  is  reached  by  abdominal  work 
at  the  level  of  the  umbilicus,  gains  marked  results  upon  the  cir- 
culation, and  through  it  upon  the  whole  metabolism  of  the  kid- 
neys. 

The  blood-vessels  and  the  muscular  coat  of  the  bladder  are 
supplied  by  the  vesical  plexus.  It  consists  of  numerous  nerves 
from  the  lower  end  of  the  pelvic  plexus  to  the  side  and  lower  part 
of  the  bladder.  The  supply  to  the  fundus  of  the  bladder  is  from 
the  hypogastric  plexus.  The  American  Text-Book  points  out 
that  stimulation  of  the  2nd,  3rd  and  4th  sacral  nerves  causes  re- 
flex contraction  of  the  bladder.  The  chief  motor  fibres  of  the 
bladder,  probably  supplying  the  longitudinal  muscle  fibres,  pass 
to  the  bladder  from  the  sacral  nerves,  At  the  same  time  some 
of  the  motor  fibres  passing  to  the  bladder  in  the  vesical  plexus 
rise  in  the  lumbar  nerves  and  reach  their  destination  via  the  aortic 
plexus,  inferior  mesenteric  ganglion  and  hypogastric  and  pelvic 
plexuses.  They  supply  the  circular  muscle  of  the  bladder  and  its 
sphincter. 

These  facts  explain  why  lower  spinal  lesion  is  so  often  found 
by  the  Osteopath  to  be  the  cause  of  motor  derangement  of  the 
bladder.  A  good  illustration  of  this  is  seen  in  the  lack  of  motor 
control  in  enuresis,  due  as  a  rule  to  low  lesions.  Reference  to  the 
case  reports  above  will  show  that  six  of  the  seven  cases  of'enuresis 
presented  lumbar  and  sacral  lesion. 

These  anatomical  facts  underlie  osteopathic  theory  of  renal 
diseases.  They  form  a  foundation  of  truth  for  osteopathic  pro- 
cedure. Lesion  to  these  various  important  nerve-supplies  at 
their  origin  along  the  spine  must  produce  renal  disturbance  in 
kind,  and  this  disturbance  can  be  righted  only  by  correction  of 
the  anatomical  derangement  responsible  for  them. 


210  PRACTICE    OF   OSTEOPATHY. 

ACUTE  NEPHRITIS.     (Acute  Bright 's  Disease). 

DEFINITION:  An  acute  inflammation  of  the  kidneys,  mild 
or  severe,  attended  by  structural  changes  in  the  organ. 

The  LESIONS  AND  ANATOMICAL  RELATIONS  have  been  dis- 
cussed. Lesions  occur  preferably  from  the  10th  dorsal  to  the 
upper  lumbar,  but  may  be  either  higher  or  lower.  Cervical 
lesions,  as  low  as  the  3rd  or  4th  vertebra,  may  occur. 

The  PROGNOSIS  is,  on  the  whole,  good,  still  bearing  in  mind 
the  necessity  of  guarded  prognosis  in  all  renal  diseases  as  above 
indicated.  Considering  the  seriousness  of  the  disease,  it  is  a 
matter  of  remark  how  many  cases  of  acute  Bright 's  Disease  have 
been  entirely  cured.  Good  results  are  quickly  evident  under  the 
treatment.  The  ordinary  course  of  a  few  days  to  six  weeks  is 
generally  shortened. 

According  to  Anders,  the  restoration  of  the  destroyed  epithe- 
lium and  of  the  glomerular  function  may  occur.  The  chances 
of  accomplishing  the  result  by  the  natural  method  of  restored  and 
corrected  circulation  as  brought  about  by  osteopathic  treatment 
would  seem  of  the  .best.  The  same  author  states  that  in  cases 
due  to  exposure  to  cold  and  wet,  irrespective  of  alcoholic  indul- 
gence, it  may  be  presumed  with  reason  that  there  is  some  inher- 
ent or  acquired  weakness  or  a  susceptibility  of  the  kidneys,  ren- 
dering them  the  weak  links  in  the  visceral  or  systemic  chain. 
It  is  the  osteopathic  idea  that  these  cases,  as  a  rule,  present  le- 
sions of  the  spine  of  such  a  nature  as  to  interfere  with  the  vital 
forces  distributed  to  the  kidneys.  This,  we  reason,  is  the  "in- 
herent or  acquired  weakness  or  susceptibility  of  the  kidneys  that 
renders  them  weak  links  in  the  visceral  chain,"  and  that  is  the 
real  cause  why  they  fall  victims  to  the  various  causes  ascribed  as 
the  active  agents  in  producing  the  disease.  This  explains  why 
the  poison  of  acute  infectious  diseases,  as  in  scarlet  fever,  pro- 
ducing nephritis  in  certain  cases,  has  been  able  to  unbalance  the 
already  weakened  urinary  mechanism.  The  same  explanation 
holds  good  for  all  the  ordinary  active  causes  of  the  disease.  It 
seems  to  be  the  sufficient  reason  why  one  person  (presumably 
with  spinal  lesion)  suffers  from  the  disease  while  similar  circum- 
stances have  failed  to  cause  it  in  another. 


PRACTICE    OF    OSTEOPATHY.  211 

TREATMENT:  The  general  treatment  for  nephritis,  acute 
and  chronic,  is  given  with  that  for  congestion  of  the  kidneys, 
q.  v.  Its  object,  as  stated,  is  primarily  to  gain  vaso-motor  con- 
trol, and  thus  allay  inflammation,  relieve  vascular  tension,  and, 
through  restored  and  corrected  circulation,  to  clear  away  the 
debris  from  the  tubules,  absorb  the  exudates,  check  degenerative 
or  new  growths,  and  rebuild  as  far  as  possible  the  destroyed  or 
compromised  renal  epithelium. 

Repeated  and  careful  analysis  of  the  urine  must  be  made  in 
all  cases  of  nephritis  for  signs  of  the  processes  in  the  kidneys, 
as  directed  in  standard  medical  texts. 

In  Acute  Nephritis,  aside  from  the  main  treatment  already 
discussed,  the  practitioner  must  direct  his  work  to  the  allevia- 
tion of  many  of  the  manifestations  of  the  disease.  The  general 
treatment  will  allay  many  of  the  symptoms  at  once;  others  may 
call  for  special  attention.  Uremic  symptoms  such  as  nausea, 
vomiting,  headache,  and  pain  in  the  back  are  treated  as  before 
directed.  For  the  latter,  relaxation  of  the  spinal  muscles  and 
inhibition  of  the  sensory  nerves,  (10th  to  12th  dorsal).  Convul- 
sions are  quieted  by  inhibitive  spinal  treatment  and  by 
inhibition  of  the  centers  or  local  nerve-supply  for  the  affected 
part.  The  dropsy  is  relieved  by  the  stimulation  of  the  general 
circulation  brought  about  by  the  general  treatment.  It  is 
aided  by  local  treatment  of  he  venous  flow  from  the  part 
affected,  e.  g.,  treatment  of  the  long  and  short  saphenous  veins, 
relaxation  of  the  tissues  about  the  saphenous  opening,  and  raising 
the  intestines  from  femoral  veins,  in  edema  of  the  lower  extrem- 
ities. Suppression,  if  it  occur,  yields  at  once,  generally,  to  thor- 
ough stimulation  of  the  kidney.  The  lungs  must  be  stimulated 
against  the  occurrence  of  bronchitis  or  pneumonia.  ,Ferspria- 
tion  may  be  excited  by  thorough  stimulation  of  the  spinal  sys- 
tem, heart,  and  lungs.  It  is  a  necessary  measure  for  the  relief 
of  the  system  from  the  accumulated  poisons.  As  a  rule,  it  is 
readily  accomplished  by  this  treatment.  Failing  of  this,  re- 
course should  be  had  to  the  hot  baths,  applications,  packs,  and 
the  use  of  vapor.  The  vapor  should  be  generated  at  the  bedside, 
and  be  conducted  under  the  cradled-up  bed  clothes. 

A  hot  pack  is  applied  as  follows:     The  patient  is  stripped 


212  PRACTICE    OF    OSTEOPATHY. 

and  wrapped  in  a  blanket  well  wrung  out  of  hot  water.  Over 
this  is  wrapped  a  dry  blanket,  and  over  this  a  rubber-cloth  or 
oil-cloth  cover.  These  are  kept  on  until  the  patient  has  sweat 
copiously  for  one  or  two  hours. 

-  Children  with  post-scarlatinal  nephritis  may  be  placed   in   a 
hot  bath  for  twenty,  thirty,  or  forty  minutes. 

The  patient  should  live  upon  a  bland  liquid  diet.  The 
skimmed  milk  diet  is  best.  Milk  taken  hot  is  very  good.  Butter- 
milk is  also  advised,  and  the  thin  broth  of  meat.  The  patient 
should  drink  plenty  of  water  and  lemonade. 

"Diuretics,  other  than  simple  diluent  drinks,  have  little  use 
in  acute  nephritis"  (Anders). 

The  patient  must  carefully  avoid  exposure  during  conva- 
lescence, and  must  afterward  use  great  care  in  the  matters  of 
dress,  diet,  and  exercise. 

During  the  attack  he  should  be  in  a  warm  bed,  in  a  warm 
room,  and  be  dressed  in  woolen  underwear  and  covered  with 
blankets. 

Upon  convalescence  he  must  not  return  too  suddenly  to 
solids,  especially  meat.  He  may  have  vegetables,  fruits,  cereals 
and  milk. 

The  hygiene  and  diet  of  nephritis  patients  is  a  most  impor- 
tant matter.  These  should  be  carefully  looked  after  according 
to  directions  laid  down  in  standard  works. 

The  patient  with  acute  nephritis  should  be  treated  once  or 
twice  daily,  more  treatment,  or  less,  may  be  given  as  the  prac- 
titioner's judgment  dictates. 

In  CHRONIC  EXUDATIVE  NEPHRITIS,  (CHRONIC  PARENCHY- 
MATOUS  NEPHRITIS)  AND  CHRONIC  NON-EXUDATIVE  NEPHRITIS, 
(CHRONIC  INTERSTITIAL  NEPHRITIS),  the  practitioner  must  be 
constantly  upon  his  guard.  A  fair  number  of  cases  of  chronic 
nephritis  have  been  cured  or  greatly  benefited.  In  the  former, 
the  prognosis,  while  guarded,  is  fair.  The  patient  may  be  cured, 
or  be  helped  to  enjoy  a  prolonged  and  comfortable  life.  In  these 
cases  the  practitioner  may  be  thrown  off  his  guard  by  the  fact 
that  the  disease  may  have  arisen  insidiously  without  having 
presented  marked  symptoms. 

In  the  non-exudative  form  the  prognosis  must  be  unfavor- 


PRACTICE    OF    OSTEOPATHY.  213 

able,  owing  to  the  very  serious  pathological  changes  that  have 
taken  place  in  the  organ.  Perhaps  much  can  be  done  for  the 
comfort  of  the  patient.  The  slow  progress  of  the  case  renders 
thorough  treatment  useful.  The  patient  may  be  helped  to  a 
long  and  comfortable  life. 

Concerning  lesions  and  treatment,  little  need  be  added  to 
what  has  already  been  said.  Special  manifestations  of  either 
form  may  call  for  special  treatment.  One  must  sustain  the 
entire  system,  and  be  continually  upon  his  guard  against  a  sud- 
den bad  turn  in  the  case,  or  intercurrent  maladies  or  complica- 
tions. The  retinitis  may  call  for  some  treatment  of  the  eye 
locally  and  through  the  cervical  sympathetic  and  blood-supply. 

Concerning  hygiene  and  diet,  the  same  remark  applies  as 
for  acute  nephritis. 

In  all  chronic  cases  very  much  depends  upon  the  way  in 
which  the  patient  lives.,  and  he  must  be  directed  accordingly. 
Thorough  general  treatment  along  the  lines  indicated  for  acute 
nephritis  tends  to  correct  the  chronic  changes,  congestions, 
fatty  degenerations,  destruction  of  epithelium,  exudations,  etc., 
characteristic  of  these  conditions.  The  growth  of  new  connec- 
tive tissue  may  be  limited. 

The  general  circulation  and  excretions  should  be  kept  stim- 
ulated, and  the  condition  of  all  the  organs  must  be  Ipoked  to. 

The  diet  should  be  much  as  in  the  acute  case.  Skimmed 
milk  and  butter-milk  are  useful.  Dried  bread  and  crackers 
should  be  used  during  dropsy.  When  the  dropsy  is  light  the 
diet  may  be  more  solid.  Light  meats,  vegetables,  rice  and 
fruits  may  be  had. 

The  patient  should  live  in  a  warm  dry  climate,  wear  woolens, 
and  lead  an  out  of  doors  life,  but  should  avoid  over-exercise. 

"Hygienic  and  dietetic  treatment  are  more  important  than 
medicines. ' '  (Thompson) . 

One  must  not  forget  that  in  these  cases  death  may  occur 
at  any  time,  from  dropsy,  heart-failure,  or  edema  of  the  larynx. 

Chronic  cases  should  be  treated  daily  or  three  times  per 
week,  according  to  the  needs  of  the  individual. 


214  PRACTICE    OF    OSTEOPATHY. 

AMYLOID  DISEASE  OF  THE  KIDNEY. 

This  condition  is  commonly  associated  with  chronic  par- 
enchymatous  or  interstitial  nephritis,  and  with  cachetic  con- 
ditions of  the  system,  consequently  it  is  quite  as  important  to 
treat  the  nephritis  or  the  other  disease  present  as  to  treat  for 
the  amyloid  degeneration.  It  is  especially  necessary'  to  be  on 
one's  guard  against  suppurative  processes  in  the  system,  as 
they  particularly  dispose  to  this  condition.  It  is  quite  likely 
to  be  associated  with  amyloid  changes  in  spleen,  liver,  intes- 
tines, etc. 

The  lesions  are  those  described  for  kidney  diseases,  espec- 
ially those  of  nephritis.  The  treatment  would  be  practically 
that  for  nephritis,  in  so  far  as  direct  treatment  to  the  kidney, 
is  concerned.  See  also  the  remarks  concerning  the  treatment 
of  amyloid  disease  of  the  liver.  A  general  course  of  treatment 
must  be  directed  to  upbuilding  the  health  and  to  overcoming 
the  weakness.  Dyspnea  must  be  treated  as  before  directed. 
The  liver  and  spleen  must  be  looked  after,  as  they  are  enlarged 
and  tender.  Correction  of  the  kidney  circulation  tends  to  reg- 
ulate the  quantity  of  urine,  which  is  usually  in  excess,  and  to 
free  it  of  albumen  and  casts.  This  treatment,  together  with 
treatment  to  the  heart  and  general  circulation,  reaches  the  drop- 
sical condition. 

The  diet  should  be  carefully  regulated,  and  the  patient 
should  take  plenty  of  light,  out-o-door  exercise,  as  directed  for 
other  kidney  diseases. 

FATTY  DEGENERATION  of  the  kidney  is  very  frequent  in 
chronic  parenchymatous  nephritis.  The  epithelium  of  the  glom- 
eruli  and  tubules  is  effected.  The  treatment  of  the  nephritis, 
correcting  the  circulation  in  the  organ,  must  be  relied  upon  to 
prevent  this  change,  and  to  renew  the  epithelial  cells  if  thus 
destroyed.  Thorough  general  treatment,  including  bowels,  liver, 
spleen,  etc.,  prevents  fatty  degeneration  by  preventing  the 
anemia  to  which  it  is  often  due.  Fatty  degeneration  is  less 
likely  to  take  place  under  osteopathic  treatment,  as  it  is  often 
caused  by  the  administration  of  certain  drugs,  such  as  phos- 
phorous, arsenic,  cantharides,  chloroform,  iodoform,  etc. 


PRACTICE  OF  OSTEOPATHY.  215 

PERINEPHRITIC  ABSCESS  must  be  treated  practically  as  are 
pyelitis  and  pyelonephritis,  q.  v.  Careful  search  should  be  made 
for  suppurative  disease  in  surrounding  tissues,  as  of  the  spine, 
bowel,  veriform  appendix,  liver,  etc.  Marked  cases  require 
surgical  treatment,  as  it  is  not  probable  that  large  quantities  of 
pus  could  be  safely  absorbed  into  the  circulation.  The  fever, 
lumbar  pain,  etc.,  should  be  treated  as  before  directed. 

CONGESTION  OF  THE  KIDNEYS. 

In  both  acute  or  arterial  hyperemia  and  chronic  or  venous 
hyperemia  a  good  PROGNOSIS  can,  generally  speaking,  be  expected. 
This  must,  however,  be  guarded  in  all  cases,  especially  in  the 
chronic  venous  congestion,  secondary  to  heart  and  lung  diseases. 
As  both  of  these  conditions  of  congestion  of  the  kidney  are  sec- 
ondary to  other  diseases,  and  as  each  may  precede  inflammation 
(acute  or  chronic)  of  the  kidney,  much  care  must  be  taken  in 
prognosis  and  treatment.  When  the  condition  is  secondary  the 
prognosis  must  depend  upon  that  for  the  primary  disease.  Yet, 
even  though  a  favorable  prognosis  is  limited  by  such  circum- 
stances, good  results  are  generally  gotten  upon  the  kidneys. 
They  are  very  responsive  to  treatment;  it  is  usually  readily  ef- 
fective in  producing  good  effects.  While  keeping  in  mind  the 
difficulties  presented  by  renal  cases  as  a  class,  we  can  yet  expect 
improvement  under  the  treatment.  Yet,  the  prognosis  for  cure 
is  always  to  be  guarded. 

The  LESIONS  for  kidney  diseases  have  been  discussed  above. 
In  cases  of  congestion  specific  lesion  is  expected  in  the  vaso-motor 
area,  6th  dorsal  to  2nd  lumbar.  In  cases  secondary  to  other 
disease  the  lesion  is  that  producing  such  disease,  though  auxiliary 
lesion  to  the  kidney  is  often  present  and  has  weakened  the  organ 
preliminarily  to  its  being  thus  affected.  Though  cold  and  ex- 
posure, the  toxic  products  of  various  acute  diseases,  and  other 
causes  may  produce  congestion  directly,  it  is  still  necessary  in 
most  cases  to  account  for  such  agents  especially  attacking  the 
kidneys;  to  account  for  the  disease  settling  upon  them.  There 
can  be  no  doubt  that  in  very  many  cases  it  is  the  presence  of  spinal 
lesion  which  determines  the  disease  to  the  kidneys.  This  hypoth- 
esis not  only  accounts  for  the  frequency  with  which  spinal 


216  PRACTICE    OF    OSTEOPATHY. 

lesions  are  found  in  such  cases,  but  also  explains  why  one  person 
may  become  the  victim  of  kidney  disease,  while  another  under 
a  similar  set  of  circumstances  escapes.  These  general  remarks 
apply  with  equal  force  to  the  subject  of  nephritis  before  consid- 
ered, as  do  those  upon  treatment. 

The  TREATMENT  has  for  its  object  the  correction  of  the 
vaso-motor  disturbance  evident  as  congestion  of  the  kidneys. 
It  gains  vaso-motor  control  both  directly,  by  treatment  to  the 
kidneys,  and  indirectly,  if  necessary,  by  the  treatment  of  the 
disease  to  which  the  congestion  is  secondary.  In  the  latter 
case  the  main  treatment  must  be  directed  to  the  primary  dis- 
ease. The  spinal  lesion  to  the  kidneys  must  always  be  removed. 

Treatment  to  gain  vaso-motor  control  is  made  directly  upon 
the  vaso-motor  innervation  of  the  kidneys.  This  consists  (in 
addition  to  the  removal  of  the  lesion  obstructing  them)  of  spinal 
stimulation  from  the  6th  dorsal  to  the  2nd  lumbar,  for  the  vaso- 
motor  fibres  to  the  kidneys  originating  in  this  spinal  area.  This 
includes  the  whole  splanchnic  area.  As  stimulation  over  the 
central  ends  of  the  splanchnics  and  of  the  great  sciatic  is  known 
to  cause  renal  constriction,  it  is  well  to  carry  this  spinal  stim- 
ulation down  over  the  origin  of  the  sciatic  nerve,  including  the 
4th  and  5th  lumbar  and  the  upper  three  sacral. 

This  treatment  for  the  circulation  is  aided  by  direct  work 
over  the  region  of  the  kidney.  Deep  pressure,  with  a  spread- 
ing motion,  applied  at  the  umbilicus  and  about  two  inches  above 
it,  stimulates  the  peritoneal  nerve-centers  said  to  exist  at  each 
side  of  the  umbilicus,  it  also  reaches  the  renal  and  supra-renal 
plexuses  and  aortico-renal  ganglion,  lying  upon  the  aorta  and 
renal  vessels,  the  plexus  ramifying  the  kidney  upon  the  blood- 
vessels. This  treatment  further  affects  the  renal  vessels 
mechanically,  and  relieves  them  of  tension  in  the  surrounding 
tissues. 

The  spinal  treatment  should  be  applied  especially  to  the 
region  of  the  lesser  and  renal  splanchnic.  In  these  various  ways 
the  kidney  circulation  is  equalized  and  the  inflammation  or  con- 
gestion is  reduced. 

To  aid  in  calling  the  blood  from  the  kidneys  and  in  equal- 
izing the  general  body  circulation,  general  deep  inhibitive  work 


PRACTICE    OF   OSTEOPATHY.  217 

is  made  over  the  abdomen  to  call  the  blood  to  its  vessels;  a  gen- 
eral spinal  and  neck  treatment,  particularly  directed  to  stim- 
ulation of  heart  and  lungs  and  to  the  inhibition  of  the  superior 
cervical  ganglion,  tones  the  general  circulation  and  relieves  blood- 
tension  (through  the  superior  cervical). 

A  valuable  spinal  treatment  for  stimulation  of  the  kidneys 
is  performed  with  the  patient  lying  on  his  back.  The  practi- 
tioner's hands  are  slipped,  palm  up,  beneath  the  back,  one  on 
each  side,  in  the  region  of  the  innervation  of  the  kidneys.  Now 
as  the  fingers  are  bent  at  the  metacarpo-phalangeal  knuckles, 
making  a  fulcrum  of  the  latter  upon  the  table,  the  cushions  of 
the  fingers  are  pressed  deeply  into  the  spinal  tissues,  the  weight 
of  the  patient  is  raised  by  the  fingers  thus  applied,  and  the  tis- 
sues are  drawn  laterally  away  from  the  spine.  Quick  repetetion 
of  this  movement  a  number  of  times  thoroughly  manipulates  the 
tissues  and  stimulates  the  nerve-connections  of  the  kidneys. 

The  bowels  and  skin  should  be  kept  free  and  active  by  treat- 
ment as  before  described. 

The  treatment  thus  described  applies  not  only  to  conges- 
tion of  the  kidneys,  but  to  nephritis. 

In  both  forms  of  congestion  of  the  kidneys  the  case  must 
Tse  carefully  looked  after  to  obviate  the  danger  of  its  passing 
into  inflammation;  acute  hyperemia  tending  to  acute  nephritis, 
the  passive  congestion  tending  to  become  chronic  nephritis. 

The  patient  should  be  kept  quiet,  resting  in  bed,  and  upon 
a  liquid  diet,  in  active  hyperemia.  In  venous  congestion  a  light 
diet  must  be  followed.  The  patient  should  drink  plenty  of  pure 
water.  Hot  baths  and  hot  applications  over  the  kidneys,  may, 
if  necessary,  be  used  with  advantage.  In  the  acute  form  the 
patient  should  be  seen  daily;  more  than  one  treatment  per  diem 
may  be  necessary.  In  the  venous  form  daily  treatment  should 
be  given. 

HYDRONEPHROSIS. 

DEFINITION:  A  condition  in  which  obstruction  to  ureters, 
bladder,  or  urethra  causes  accumulation  of  urine  in  the  pelvis 
.and  calyces  of  the  kidney. 

LESION  may   or  may  not  be  concerned  in  the  causation. 


218  PRACTICE    OF    OSTEOPATHY. 

It  is  said  that  about  20  to  35  per  cent  of  the  cases  are  duo  to 
congenital  obstruction.  Prostatitis,  causing  urethral  stricture 
may  be  the  cause,  itself  dependent  upon  a  bony  lesion.  The 
same  is  true  of  displaced  uterus  -pressing  upon  the  ureter;  of  a 
tumor  or  growth  in  the  contiguous  tissues  pressing  upon  the 
ureter:  of  an  inflammation  of  the  urethra,  leading  to  obstruction; 
disease  of  the  bladder  involving  the  urethral  orifice;  of  a  floating 
or  movable  kidney,  causing  a  twist  in  the  ureter.  Parasites,  or 
calculi  may  obstruct  the  tube. 

The  TREATMENT  must  be  directed  to  the  relief  of  the  pa- 
tient, but  chiefly  to  the  removal  of  the  obstructing  cause.  This 
may  not  always  be  feasible,  but  is  often  possible.  A  careful 
study  must  be  made  of  the  history  of  the  case  to  determine  the 
probable  nature  of  the  obstruction.  A  movable  kidney  must 
be  carefully  raised,  straightening  out  the  ureter,  manipulation 
being  directed  particularly  to  this  end.  All  manual  operations 
in  such  cases  must  be  conducted  with  extreme  care  to  avoid 
rupture.  A  movable  kidney  may  be  held  in  place  by  strengthen- 
ing its  omental  supports  and  the  abdominal  walls  (see  movable 
kidney).  Reducing  an  enlarged  postate,  replacing  a  prolapsed 
uterus,  or  dilating  the  ureter  and  working  the  calculus  or  para- 
sites down  out  of  it,  ma}-  be  all  the  treatment  necessary.  (See 
Chap.  TX  D.,  Renal  Calculi.  Uterine  Diseases). 

The  bony  lesion  must  be  removed.  A  continued  course 
of  treatment  should  be  carried  on  to  overcome  the  atrophy  of 
the  renal  epithelium  and  the  growth  of  connective  tissue  that 
has  likely  taken  place. 

TUMORS  OF  THE  KIDNEY  of  the  benign  variety,  such  as  fibro- 
ma, lymphadenoma,  angiomia,  lipoma,  may  be  amenable  to  the 
treatment.  The  malignant  tumors,  sarcoma  and  carcinoma, 
probably  would  not  be.  The  latter  is  almost  invariably  fatal 
and  removal  by  surgery  seems  to  be  only  resort.  The  treat- 
ment and  lesions  in  these  conditions  are  as  described  in  the  chap- 
ter on  tumors,  q.  v.  An  obstructed  venous  or  lymphatic  cur- 
rent is  probably  most  potent  in  causing  them. 

CYSTIC  KIDNEY.  OR  RENAL  CYST,  is  a  condition  that  is  usually 
remediable  only  by  surgery.  The  treatment  would  be  palliative, 
and  of  the  kind  described  for  nephritis,  to  the  chronic  interstitial 


PRACTICE    OF   OSTEOPATHY.  219 

variety  of  which  the  cysts  are  often  due.  The  kidney  excretions 
should  be  kept  free  by  plenty  of  stimulative  treatment  to  the 
organs,  to -guard  against  the  sudden  occurrence  of  uremia  in  the 
patient.  The  heart  is  often  hypertrophied,  and  should  be  treated 
as  directed  for  that  condition.  In  retention  cysts  due  to  chronic 
interstitial  nephritis,  much  might  be  accomplished  in  the  measure 
that  the  nephritis  is  benefited,  which  is  often  considerable.  The 
patient's  life  may  be  rendered  safe  and  be  much  prolonged  by 
the  treatment.  Just  what  would  be  accomplished  in  these  cases 
is  still  an  open  question. 

RENAL  CALCULI,  (Nephrolithiasis). 

DEFINITION:  Fine  or  coarse  concretions  in  the  substance 
of  the  kidney  or  in  the  renal  pelvis,  resulting  from  precipitation 
of  the  solid  constituents  of  the  urine.  It  is  due  to  spinal  lesion 
which  disturbs  the  normal  secretory  activities  of  the  kidney 
and  leads  to  the  deposition  of  certain  substances. 

The  LESIONS  AND  ANATOMICAL  RELATIONS  have  been  dis- 
cussed under  the  general  consideration  of  renal  diseases.  Les- 
ions from  the  10th  dorsal  to  the  1st  lumbar,  including  those 
of  the  lower  two  ribs,  are  the  most  frequent  in  these  cases.  No 
pathognomonic  lesion  has  been  located  for  this  condition.  From 
the  nature  of  the  case,  any  lesion  interfering  with  the  proper 
innervation  and  circulation  of  the  kidney  might  so  interfere  with 
normal  secretions  as  to  render  them  disproportionate  or  excessive 
as  to  certain  constituents.  Whether  the  stone  be  of  uric  acid 
or  urates.  of  calcuim  oxalate,  phosphates,  or  some  other  sub- 
stance, it  is  clear  that  some  cause  is  operating  which  prevents 
the  natural  proportions  of  the  renal  constitutents  from  being 
maintained.  While,  as  Anders  states,  the  causes  are  not  well 
known,  the  osteopathic  view  is  that  the  real  cause  is  fouud  in 
spinal  lesion  which  deranges  the  vital  forces  underlying  kidney 
activity.  It  is  as  reasonable  that  spinal  lesion  should  unbalance 
the  delicate  sympathetic  nerve-mechanism  controlling  these 
o  grans,  leading  to  disproportionate  or  excessive  secretion  of  the 
urinary  constituents  and  the  precipitation  of  the  stone,  as  that 
spinal  lesion  should  in  a  similar  way  disturb  intestinal  secretion 
and  lead  to  diarrhoea.  Dr.  Still  points  to  the  fact  that  the  supra- 


PRACTICE   OF    OSTEOPATHY. 

renal  bodies  have  a  rich  arterial  supply,  and  believes  that  theii 
secretions  have  to  do  with  preventing  renal  calculi.  They 
should  be  stimulated  at  the  level  of  the  10th  rib  in  such  cases. 
Lesion  to  them  may  be  one  of  the  causes  of  renal  calculi. 

The  PROGNOSIS  is  good,  both  for  the  removal  of  the  stone 
and  for  the  prevention  of  its  further  formation.  Immediate 
relief  is  usually  given  in  the  case  of  renal  colic,  and  the  case  is 
entirely  cured  under  the  treatment.  The  treatment  of  these 
cases  is  almost  uniformly  successful. 

The  TREATMENT  has  as  its  object  the  removal  of  the  stone 
and  the  correction  of  the  metabolism  of  the  kidney  to  pievent 
stones  being  formed  again.  The  stone  may  be  removed  in  one 
of  two  ways.  Correction  of  the  activities  of  the  organ  will  lead 
to  disintegration  of  the  stone.  Renal  secretions  dissolve  kidney 
stones.  (A.  T.  Still).  Stones  too  large  to  pass,  formed  by  the 
precipitation  of  insoluble  substances  necessitate  operation.  This 
corrective  work  embraces  the  removal  of  lesion,  and  general  stim- 
ulation of  controlling  nerves  and  circulation.  This  is  accom- 
plished by  both  spinal  and  local  abdominal  treatment  as  before 
described  in  the  treatment  of  the  kidney.  Under  this  restorative 
process  normal  urine  is  secreted  and  the  stone  is  dissolved. 

This  same  procedure  would  prevent  the  formation  of  more 
calculi.  It  would  be  efficient  in  all  cases,  and  should  be  ad- 
ministered to  cases  passing  renal  sand  or  gravel  without  pain  as 
a  prophylactic  against  worse  conditions,  and  to  cure  the  case. 
It  corrects  those  conditions  favoring  precipitation;  lessens  the 
ascidity  of  the  urine,  dispels  the  uric  acid,  increases  the  salines,  etc. 

The  stone  may  also  be  removed  by  manipulation  of  it  along 
the  ureter  and  into  the  bladder.  The  practitioner  is  generally 
called  to  these  cases  during  an  attack  of  renal  colic.  Under 
these  conditions  the  first  step  is  to  allay  the  usually  extreme  pain. 
First,  spinal  inhibition  is  to  be  made.  As  the  sensory  innerva- 
tion  is  through  the  sympathetic,  from  the  10th  dorsal  for  the 
upper  part  of  the  ureter,  while  at  the  lower  end  the  1st  lumbar 
probably  supplies  the  structure,  strong  inhibition  (as  in  diarrhoea) 
must  be  made.  This  inhibitive  treatment  for  the  pain  probably 
also  aids  in  dilating  the  ureter  for  the  passage  of  the  stone.  Quiet- 
ing the  colic  must  itself  be  in  the  nature  of  a  relaxation  of  the 


PRACTICE  OF  OSTEOPATHY.  221 

tissues  of  the  ureter.  This  treatment  is  a  step  preliminary  to 
the  abdominal  treatment  along  the  course  of  the  ureter,  which 
has  for  'its  object  the  inhibition  of  pain,  relaxation'of  the  ureter, 
and  the  manipulation  of  the  stone  downward  along  the  duct. 
As  the  pain  spreads,  and  is  very  likely  to  extend  down  the  spine 
to  the  testacle  or  inner  side  of  the  thigh,  it  is  well  to  carry  the 
inhibition  from  the  middle  dorsal  down  over  the  sacrum.  After 
this  treatment  abdominal  work  is  better  borne.  This  is  a  very 
deep,  firm,  but  not  rough,  treatment  over  the  course  of  the  ureters. 
It  is  slow,  inhibitive  and  relaxative,  thus  helping  to  quiet  the 
pain,  and  relaxing  the  ureter  for  the  passage  of  the  stone.  This 
relaxation  may  be  aided  by  inhibition  of  the  inferior  mesenteric, 
spermatic,  and  pelvic  (lower  hypogastric)  plexuses.  This  treat- 
ment aids  the  ureter  to  pass  the  stone  by  mechanically  working 
it  along.  It  should  be  begun  at  a  point  two  inches  above  and 
two  inches  externally  from  the  umbilicus  and  progress  diagonally 
downward  and  inward  to  the  promontory  of  the  sacrum  and  as 
far  below  it  as  possible.  This  treatment  reaches  the  ureter  by 
deep  pressure  of  the  overlying  tissues  down  upon  it.  It  must  be 
very  deep,  but  slow  and  with  the  careful  avoidance  of  any  vio- 
lence. Usually  the  stone  is  readily  passed  under  the  treatment, 
but  some  cases  require  nearly  a  continuous  treatment  for  a  con- 
siderable time,  three  quarters  of  an  hour  or  more.  If  possible, 
treatment  should  not  be  stopped  until  the  stone  is  passed.  Treat- 
ment afterwards  over  the  sore  parts  may  be  necessary.  The 
patient's  system  should  be  stimulated  against  syncope  or  col- 
lapse by  treatment  of  the  heart,  lungs,  and  cervical  region. 

The  patient  should  be  directed  to  avoid  red  meats  and  those 
articles  of  drink  and  diet  favoring  uric  acid.  He  should  lead  a 
temperate  life,  taking  moderate  exercise.  The  drinking  of  lemon- 
ade, soda  water,  and  plenty  of  pure  water  is  a  valuable  aid  in 
keeping  the  kidneys  flushed  and  free.  Hot  baths,  and  the  applica- 
tion of  hot  fomentations  or  poultices  to  the  loins,  afford  relief 
in  the  acute  attack. 

PYELITIS,  if  present,  must  be  treated  (aside  from  the  removal 
of  the  stone  from  the  pelvis)  as  the  inflammatory  condition  of  the 
kidneys  before  discussed. 

PYELONEPHRITIS  results  from  an  extension  of  the  inflam- 


222  PRACTICE  OF  OSTEOPATHY. 

mation  inward  to  involve  the  substance  of  the  kidney.  Both 
of  these  conditions  are  to  be  regarded  in  the  light  in  which  nephri- 
tis is  looked  at,  and  call  for  practically  the  same  treatment  (See 
nephrtis.)  Careful  attention  must  be  given  the  conditions  causing 
the  disease.  Irritant  calculi  may  sometimes  be  absorbed  from 
the  pelvis  of  the  kidney,  or  may  have  to  be  removed  by  surgical 
operation.  A  cystitis,  the  inflammation  from  which  extends  up- 
ward to  involve  the  pelvis  and  kidney,  must  be  carefully  looked 
after.  (See  cystitis). 

In  a  similar  way  infectious  diseases,  irritant  drugs,  cold  and 
exposures,  etc.,  acting  as  the  cause  of  the  pyelitis  and  pylone- 
phritis,  must  be  attended  to.  Bony  lesion  must  be  removed. 

The  inflammation  is  sometimes  simply  catarrhal  in  nature 
and  is  easily  overcome  by  the  corrected  circulation.  Ulceration 
may  occur  in  the  pelvis  from  the  continued  irritation  of  calculi, 
and  tissue  changes  occur.  In  such  cases  a  longer  course  of  treat- 
ment will  be  necessary  to  overcome  these  conditions. 

From  severe  irritation,  and  in  the  course  of  infectious  dis- 
eases, a  purulent  process  may  be  set  up.  This  exudate,  and 
strictures,  may  obstruct  the  kidney,  and  ABSCESS  OF  THE  KID- 
NEY, or  PYONEPHROSIS  occurs.  In  such  cases  the  treatment  is 
upon  the  same  plan,  but  the  prognosis  is  not  so  favorable.  The 
process  may  be  limited  and  the  case  be  cured  by  the  treatment. 
Surgical  treatment  may  become  necessary.  In  all  of  these  cases, 
especially  in  those  with  purulent  features,  constitutional  treat- 
ment must  be  given. 

MOVABLE  KIDNEY  (Nephroptosis,  Displaced  Kidney)  may 
be  successfully  treated  by  osteopathic  means  if  it  has  not  that 
extreme  degree  of  mobility  known  as  "floating  kidney."  Mov- 
able kidney  is  the  term  designating  the  condition  in  which  the 
upper  end  of  the  organ  may  be  pushed  down  to  the  level  of  the 
umbilicus.  The  lesions,  so  far  as  this  condition  may  be  traced 
to  them,  are  of  the  sort  producing  enteroptosis,  q.  v.  There  is 
usually  present  a  slight  curvature  of  the  dorso-lumbar  spine 
(McConnell).  A  bad  spinal  condition,  or  a  definite  single  lesion, 
compromises  blood  and  nerve-supply  of  the  organ  and  its  related 
tissues,  weakens  the  tissues  and  vessels  supporting  it  in  place, 
and  allows  of  a  prolapsus  of  the  organ  directly  or  by  allowing 


PRACTICE    OF    OSTEOPATHY.  223 

other  causes  to  operate.  Thus  it  occurs  as  a  part  of  enteroptosis, 
or  from  falls,  heavy  lifting,  straining  at  stool,  etc.  Spinal  lesions 
causing  relaxed  abdominal  walls  also  repeated  pregnancies  pro- 
ducing the  same  result,  favor  mobility  of  the  kidneys.  Lesions 
and  diseases  leading  to  extreme  emaciation  and  consequent 
wasting  of  the  fatty  tissues  of  the  capsule  o  the  kidney  may 
cause  this  condition,  as  may  also  tight  lacing. 

TREATMENT:  From  the  nature  of  these  causes  it  may  be 
seen  that  one's  chances  of  curing  a  moderate  degree  of  movabl 
kidney  are  good,  the  causes  being  removable.  Much  the  same 
treatment  would  be  given  as  for  enteroptosis.  q.  v.  The  re- 
moval of  spinal  lesion,  spinal  treatment  to  restore  tone  to  the 
supporting  tissues,  local  treatment  at  the  kidney  to  mechanically 
replace  it  and  to  remove  the  tenderness  and  swelling  in  it  due  to 
twisting  of  the  renal  vessels,  and  abdominal  treatment  to  re- 
store tone  in  the  surrounding  and  supporting  tissues  would  all 
be  useful.  In  cases  suffering  from  extreme  emaciation  attention 
should  be  "given  to  the  general  health  and  to  increasing  the  nutri- 
tion of  the  body.  Abdominal  supporters  and  pads  should  be 
gradually  laid  aside,  the  abdominal  muscles  being  toned  to  act 
in  their  stead .  The  neurasthenia  and  general  nervous  symptoms, 
indigestion,  palpitation,  irritable  bladder,  etc.,  call  for  general 
treatment  of  the  nervous  system  coupled  with  special  treatment 
for  any  particular  troublesome  manifestation. 

The  patient  should  have  plenty  of  rest  lying  down,  and 
should  avoid  over-exertion,  over-eating,  straining  at  stool,  etc. 

SPECIAL  PATHOLOGICAL  STATES  OF  THE  URINE,  such  as 
Hematuria,  Albuminuria,  Lithuria,  Oxaluria,  and  various  other 
conditions,  hardly  call  for  special  discussion.  They  depend 
upon  pathological  states  of  the  kidney,  and  are  adequately  treated 
along  with  the  various  kidney  diseases  with  which  they  occur, 
as  symptoms  or  complications. 

UREMIA. 

DEFINITION:  An  acute  or  chronic  condition  due  to  acute 
or  chronic  kidney  disease,  and  resulting  from  toxemia  caused  by 
the  retention  in  the  blood  of  renal  poisons. 

Uremia   is   symptomatic,  therefore   no   separate   lesions  are 


224  PRACTICE    OF    OSTEOPATHY. 

expected  for  it.  They  are  those  causing  the  primary  disease 
from  which  the  patient  is  suffering,  most  frequently  Bright 's 
disease,  but  quite  often  also  such  diseases  as  gout,  scarlet  fever, 
typhoid  fever,  cholera,  etc.;  conditions  in  which  the  blood  and 
kidneys  are  affected. 

The  PROGNOSIS,  while  guarded,  is  fair.  In  the  acute  form 
rapid  work  must  be  done  to  obviate  the  danger  of  a  fatal  termina- 
tion. The  treatment  quickly  relieves,  however,  and  usually 
the  kidneys  can  soon  be  gotten  to  acting  freely. 

In  the  chronic  case  one  must  be  continually  upon  his  guard 
against  a  bad  turn.  The  chances  in  these  cases  are  better  than 
in  the  acute,  to  overcome  the  condition. 

The  prognosis  must  always  depend  upon  that  for  the  pri- 
mary disease. 

The  TREATMENT,  especiahV  in  the  acute  case  must  be  prompt- 
ly efficient.  The  first  object  is  to  arouse  the  kidneys  to  activ- 
ity, and  to  excrete  from  the  system  the  poison  that  is  causing  the 
trouble. 

Thorough  stimulation  at  the  renal  region  of  the  spine  for- 
tunately soon  accomplishes  this  object.  Cases  that  have  not 
urinated  in  many  hours  will  often  respond  promptly  to  this  treat- 
ment. Reference  to  cases  reported  above  will  give  an  indication 
of  what  may  be  done.  The  accomplishment  of  this  ob- 
ject is  furthered  by  the  local  treatment  to  the  kidneys,  renal 
vessels,  and  associated  nerve  plexuses,  given  upon  the  abdomen 
at  and  above  the  umbilicus.  For  this  abdominal  treatment,  and 
a  special  treatment  for  these  cases,  see  the  treatment  of  congest- 
ion of  the  kidneys.  Catheterization  should  be  employed  when 
necessary. 

Sweating  should  be  induced  in  order  to  help  free  the  blood 
of  the  poisons.  Thorough  spinal  treatment,  and  stimulation  of 
heart  and  lungs  will  cause  perspiration.  A  hot  pack  may  be  used 
for  this  purpose  if  necessary.  The  stimulation  of  the  heart  over- 
comes the  feeble  and  labored  beating  of  the  heart,  while  the 
stimulation  of  the  lungs,  raising  of  the  ribs,  etc.,  relieves  the 
dyspnea.  (Cheyne-Stokes  breathing  is  often  present). 

For  the  convulsions  general  relaxation  of  the  spinal  and 
cervical  tissues  should  first  be  done,  followed  by  strong  inhibi- 


PRACTICE    OF    OSTEOPATHY.  225 

tion  in  the  superior  cervical  region,  affecting  the  vaso-motor 
center  in  the  medulla.  This  treatment,  together  with  the  stim- 
ulation of  the  heart,  corrects  the  circulation  to  the  brain.  The 
spasms  are  supposed  to  be  due  to  localized  or  general  anemia  of 
the  brain  and  cerebral  anemia. 

The  eye  and  ear  symptoms,  such  as  dimness  of  vision,  blind- 
ness, tinnitus  aurium,  deafness,  etc.,  are  of  centric  origin,  and  are 
remedied  by  restoring  the  circulation  to  the  brain.  They  do  not 
commonly  last  more  than  a  few  days  in  the  course  of  the  disease. 

Fever  may  be  present  and  should  be  treated  as  before  di- 
rected. Bowels  and  skin  should  be  kept  active.  The  bowels 
may  be  made  to  respond  to  treatment,  or  may  be  emptied  by 
an  enema.  Subnormal  temperature  is  normalized  by  the  heart 
and  lung  treatment.  The  coma  is  reached  by  the  spinal  and 
cervical,  and  heart  and  lung  treatment  as  described. 

The  vomiting,  nausea,  diarrhoea,  stomatitis,  etc.,  should  be 
treated  as  before  directed  for  those  conditions.  They  depend 
upon  the  irritation  of  the  mucosa. 

CYSTITIS. 

DEFINITION:  An  acute  or  chronic  inflammation  of  the 
mucous  membrane  of  the  bladder. 

LESIONS  AND  ANATOMICAL  RELATIONS:  Lumbar  and  sacral 
lesions  predominate  in  bladder  troubles.  The  urino-genital 
center  occurs  in  the  spine  from  the  2nd  to  5th  lumbar,  while 
the  sensory  nerve-supply  to  the  mucous  membrane  and  neck 
of  the  bladder  is  derived  from  the  (1st),  2nd,  3rd  and  4th  sacraL 
The  vesical  plexus  is  derived  from  the  lower  end  of  the  pelvic 
plexus  and  supplies  vaso-motor  fibres  to  the  blood-vessels  of  the 
bladder.  Through  the  pelvic  plexus  it  is  in  connection  with  both 
lumbar  sympathetic  and  sacral  nerves,  hence  may  be  subject  to 
the  effect  of  lumbar  or  sacral  lesion,  acting  to  derange  the  blood- 
supply  of  the  bladder.  Such  lesion  weakens  this  circulation  and 
renders  the  bladder  liable  to  the  action  of  various  causes  to  pro- 
duce the  cystitis.  In  this  way  cold  or  exposure  could  cause  the 
condition.  Through  lesion  to  the  motor  nerves  of  the  bladder 
(See  Enuresis),  a  paresis  of  the  bladder  walls  may  be  caused, 
leading  to  cystitis.  An  enlarged  prostate  may  cause  pressure 

15 


226  PRACTICE    OF    OSTEOPATHY. 

upon  the  bladder  and  retention  of  urine,  leading  to  the  disease. 
Traumatism,  such  as  the  careless  use  of  catheter  or  sound,  irrita- 
tion of  fecal  matter,  or  of  a  stone  in  the  bladder,  or  from  a  preg- 
nant uterus,  may  be  a  sufficient  cause.  This  is  also  true  of  septic 
causes  of  cystitis;  the  introduction  of  an  unclean  catheter,  the 
poisonous  products  of  febrile  diseases,  of  gonorrhrea,  etc.,  becom- 
ing direct  causes  of  the  condition.  Yet,  in  many  of  such  cases, 
the  weakness  of  parts  due  to  spinal  lesion  precedes  and  predis- 
poses to  the  trouble.  Also  lesion  is  often  the  direct  cause  of 
the  condition  leading  to  cystitis,  as  in  inflammation  of  the  sur- 
rounding organs;  vaginitis,  urethritis,  etc. 

The  TREATMENT  is  to  restore  normal  circulation.  It  is 
upon  that  part  of  the  spine  pointed  out  above  as  related  directly 
to  the  vaso-motor  innervation  of  the  bladder.  Lesion  in  these 
areas  must  be  removed.  Such  treatment  is  often  followed  by 
great  relief  at  once.  Local  abdominal  treatment  over  the  course 
of  the  internal  iliac  veins  aids  in  reducing  the  inflammation.  The 
abdominal  treatment  must  be  carefully  applied.  It  may  be  made 
over  the  hypogastric  plexus  to  aid  in  controlling  the  circulation. 
It  should  be  inhibiti,ve.  Inhibitive  and  relaxing  treatment  aids 
in  quieting  the  pain  and  vescical  irritability.  It  also  calls  the 
blood  to  the  abdominal  vessels  away  from  the  bladder.  An  en- 
larged prostate  must  be  reduced,  (Chap.  IX.  D.)  and  mechanical 
irritants  must  be  removed  if  possible. 

For  the  pain  and  irritation  of  the  bladder,  strong  inhibition 
should  be  made  from  the  1st  lumbar  down,  especially  over  the 
2nd,  3rd  and  4th  sacral  nerves.  For  the  vescical  and  rectal  tenes- 
mus,  stimulation  of  the  lumbar,  and  especially  of  the  sacral 
region  should  be  made  after  the  pain  is  allayed.  For  all  of  these 
pains  a  good  treatment  is  to  have  the  patient  lie  upon  his  back, 
and  strong  pressure  is  made  upon  the  pubic  arch;  or  better,  have 
him  lie  upon  his  chest,  and  the  practitioner  brings  the  heavy 
pressure  upon  the  sacrum. 

The  patient  should  remain  lying  down,  as  it  is  said  that  then 
the  intra- vescical  pressure  is  but  one-third  as  great  as  in  the 
erect  position.  The  diet  should  be  simple,  avoiding  highly  sea- 
soned foods  and  alcohol.  In  the  early  stages  a  milk  diet  is  rec- 
ommended. The  patient  should  drink  freely  of  water  for  internal 


PRACTICE    OF    OSTEOPATHY.  227 

irrigation  of  the  bladder.  Treatment  should  be  given  to  keep 
active  the  cutaneous  circulation  (2nd  dorsal,  5th  lumbar,  superior 
cervical).  This  is  aided  by  general  spinal  treatment,  by  friction 
of  the  skin,  and  by  bathing.  The  bowels  must  be  kept  open  and 
the  kidneys  free.  The  usual  treatments  should  be  given  for  this 
purpose.  Hot  sitz  baths  and  hot  applications  may  be  employed 
to  relieve  the  pain  in  the  intervals  between  treatments,  if  neces- 
sary. 

The  patient  should  be  treated  once  or  twice  daily. 

In  the  chronic  case  the  prognosis  is  fair,  but  guarded.  Treat- 
ment should  proceed  along  the  lines  laid  down  above.  In  this 
form,  and  in  septic  cystitis,  washing  out  the  bladder  is  a  val- 
uable aid  to  the  treatment.  For  the  chronic  case  boiled  water, 
sterile  normal  salt  solution  (40-<>0  gr.  to  a  pint),  or  a  weak  solu- 
tion of  mercuric  chlorid  (1:50,000  or  100,000)  are  recommended. 
For  septic  cases,  a  saturated  solution  of  boric  acid  may  be  used. 

ENURESIS,  (Incontinence  of  Urine). 

DEFINITION:  Inability  to  retain  the  urine.  A  neurosis 
due  to  sacral  or  lumbar  lesion  which  so  affects  the  motor  nerve 
mechanism  of  the  bladder  as  to  result  in  lack  of  control. 

LESIONS  AND  ANATOMICAL  RELATIONS:  The  lesions  usually 
occur  in  the  lower  lumbar  and  sacral  regions.  They  have  been 
discussed  in  the  beginning  of  the  chapter  on  renal  diseases  (see 
ante).  Frequently  some  single  lesion,  as  of  the  2nd  or  5th  lum- 
bar, is  found,  the  removal  of  which  cures  the  case  at  once.  A 
common  lesion  is  weakness  and  posterior  position  of  the  whole 
lumbar  spine.  Quite  often  lower  dorsal  lesion  is  found.  An- 
terior lesion  of  the  5th  lumbar  is  a  frequent  cause. 

As  the  vesical  plexus  supplies  the  muscular  coats  of  the 
bladder,  and  as  it  is  in  connection,  through  the  pelvic  'plexuses, 
with  both  the  lumbar  and  sacral  nerves,  lesions  of  these  por- 
tions of  the  spine  may  readily  affect  the  motor  activities  of  the 
bladder.  This  becomes  more  evident  in  the  light  of  the  fact 
that  the  motor  fibres  of  the  circular  muscles  and  sphincter  of  the 
bladder  are  derived  from  the  lumbar  portion  of  the  sympathetic 
namely,  from  the  llth  and  12th  dorsal  and  the  1st  and  2nd  lum- 
bar spinal  nerves  connecting  with  the  sympathetic  by  way  of 


228  PRACTICE    OF    OSTEOPATHY. 

the  aortic  plexus,  the  inferior  mesenteric  ganglion,  the  hypogas- 
tric  and  pelvic  plexuses.  On  the  other  hand,  the  2nd,  3rd,  and 
4th  sacral  nerves  furnish  the  chief  motor  supply  to  the  longitu- 
dinal muscle  fibres  of  the  bladder.  (Quain).  The  American 
Text-Book  of  Physiology  states  that  stimulation  of  the  sacral 
nerves  (1st,  2nd,  3rd  and  4th)  causes  a  reflex  contraction  of  the 
bladder.  It  is  evident  that  lumbar  and  spinal  lesion  may  di- 
rectly affect  this  nerve-supply.  The  lesion  involving  the  sphinc- 
teric  center  of  the  bladder;  the  paralytic  incontinence;  the 
imperfect  vesical  innervation  and  paresis  of  the  walls  from  over 
distention;  the  spasmodic  incontinence  due  to  over  action  of  the 
compressor  muscle  of  the  bladder,  may  all  arise  from  spinal  les- 
ion as  described  occurring  at  certain  or  various  points  in  the 
lumbar  and  sacral  regions.  This  lesion  may  cause  a  stoppage 
of  nerve-supply,  resulting  in  a  paralytic  condition,  or  in  an  irri- 
tation of  the  bladder.  The  anatomical  relation  between  lesion 
and  disease  is  clear  in  this  case. 

The  PROGNOSIS  is  good.  Very  many  cases  have  been  suc- 
cessfully treated.  Generally  quick  results  are  attained.  Treat- 
ment causes  immediate  lessening  of  the  trouble.  Cure  is  the 
rule. 

TREATMENT:  The  relation  of  lesion  to  disease  is  so  close 
in  this  disease  that  the  first  step  is  to  remove  the  lesion.  This 
may  be  all  the  treatment  necessary.  A  thorough  stimulation 
of  the  lumbar  and  sacral  region  affects  the  nerve-connections 
explained  above  and  tones  the  motor  mechanism  of  the  bladder. 
Spasmodic  conditions  call  for  thorough  inhibition  of  these  re- 
gions. Corrective  spinal  work  restores  normal  conditions  and 
allows  Nature  to  attend  to  the  result.  Abdominal  treatment 
over  the  hypogastric  plexus  and  over  the  internal  liiac  vessels 
aids  the  case.  When  the  condition  is  due  to  a  prostrating  dis- 
ease the  treatment  must  be  directed  as  well  to  the  upbuilding  of 
the  system.  A  prolapsed  uterus  must  be  replaced,  and  other 
irritating  causes  removed.  Among  the  latter  may  be  intestinal 
worms,  an  elongated  prepuce,  etc.  Circumcision  is  advisable 
in  the  latter  case.  In  neurotic  children  treatment  must  be  given 
to  the  general  nervous  syste.  Enjoin  regularity  of  habits  in 
children,  and  regulate  diet  and  drink,  especially  for  the  latter 


PRACTICE    OP   OSTEOPATHY.  229 

part  of  the  day.  Avoid  late  play;  all  worry,  and  excitement. 
The  child  should  sleep  in  a  cool  room,  under  light  covers.  The 
hips  may  be  elevated  a  little.  Keep  the  rectum  empty. 

RENAL  DROPSY. 

DEFINITION:  This  is  "an  abnormal  accumulation  of  watery 
fluid  transuded  from  the  blood-vessels  into  the  cellular  tissues 
and  lymph-spaces."  "A  toxemic  edema"  (Butler).  It  is  a 
common  occurrence  in  acute  and  chronic  nephritis  and  in  other 
form  of  kidney  diseas3. 

The  lesions  are  those  causing  the  primary  disease  of  the 
kidneys. 

The  prognosis  is  good,  the  condition  yielding  quickly  to 
treatment.  The  kidneys  become  very  active  under  treatment 
and  throw  off  the  accumulated  fluid  from  the  system.  In  case 
3,  under  "Diseases  of  the  Urinary  System,"  great  dropsical  swell- 
ing of  the  body  from  feet  to  middle  of  the  back  was  quickly  over- 
come by  treatment.  Under  the  subject  "Ascites"  is  reported 
a  case  in  which  enormous  quantities  of  the  fluid  were  passed 
from  the  system  by  the  kidneys  which  were  kept  well  stimulated. 

The  TREATMENT  is  for  the  removal  of  lesion  and  the  cure  of 
the  primary  disease  of  the  kidneys.  The  organs  must,  them- 
selves, be  kept  thoroughly  stimulated  by  treatments  described 
in  "Congestion  of  the  Kidneys,"  q.  v.  The  heart  should  be  kept 
thoroughly  stimulated  to  overcome  its  weakness,  a  feature  quite 
important  in  these  cases.  This  treatment  aids  in  overcoming 
the  venous  stasis  present  in  the  whole  system.  Any  special  dis- 
ease of  the  heart  present  should  be  given  due  attention.  It  is 
apt  to  be  dilated  as  well  as  weak.  Any  lesion  affecting  the  heart 
should  be  removed.  An  important  effect  is  gotten  upon  the 
heart  by  the  thorough  treatment  to  the  kidneys,  thus'  lessening 
the  vascular  tension  in  the  system  due  to  the  kidney  disease. 
(See  Dilatation  of  the  Heart,  for  treatment). 

It  is  thought  that  the  accumulation  of  fluid  in  the  tissues 
is  due  to  the  relaxation  and  loss  of  elasticity  in  them.  This 
prevents  the  forcing  of  the  lymph  into  circulation,  and  allows  the 
fluid  to  infiltrate  the  tissues.  For  this  condition  a  thorough  gen- 
eral spinal  and  muscular  treatment  is  necessary  to  increase  the 
activity  of  the  circulation,  and  to  add  tone  to  vessels  and  tissues. 


230  PRACTICE  OF  OSTEOPATHY. 

DISEASES  OF  THE  HEART  AND  CIRCULATORY  SYSTEM. 

As  in  considering  the  diseases  of  the  urinary  system,  a  num- 
ber of  cases  are  here  noted  for  their  value  in  showing  various  facts 
in  regard  to  the  practice  upon  cases  of  this  class.  The}-  show 
either  important  lesion,  the  removal  of  which  cured  the  disease; 
quickness  of  results  gained  by  osteopathic  treatment  in  serious 
or  long  standing  cases,  unrelieved  by  other  methods  of  treat- 
ment; and  something  of  the  variety  and  range  of  the  practice  in 
these  cases.  These  reports  as  far  as  they  go,  are  typical  of  the 
practice.  They  are  not,  however,  presented  as  model  case  re- 
ports, nor  as  representing  the  whole  field  of  practice  in  diseases 
of  this  class. 

(1)  Fatty    degeneration    of    the    heart.  'The    patient    was 
too  weak  to  walk ;  the  action  of  the  heart  was  very  weak ;  arrhyth- 
mia was  present;  great  dropsy  of  the  lower  limbs  prevailed.     The 
patient  could  sleep  only  by  kneeling  over  a  couch  with  the  chest 
supported  by  pillows.     This  position  relieved  irritation  from  the 
lesion.     Lesion  was  marked;  there  was  great  contracture  of  the 
muscles  from  the  atlas  to  the  6th  dorsal,  especially  marked  in 
the  upper  dorsal  region.     The  patient  was  very  round  shouldered. 
These  causes  brought  about  a  drawing  together  of  the  sternal' 
ends  of  the  ribs,  and  lessened  the  cavity  of  the  chest,  allowing 
of  less  room  for  the  heart's  action.     For  two  weeks  the  patient 
was  treated  daily,  and  could  then  lie  down  to  sleep.     After  one 
month  he  could  walk  a  quarter  of  a  mile  to  the  office  for  treatment 
and  return  unaided.     At  the  end  of  a  three  month  course  of 
treatment  he  returned  home  to  work,  and  was  well  two  years  later. 

(2)  A  case  of  palpitation  of  the  heart,  with  goitre,  uterine 
disease,  etc.,  presented  contracture  of  the  spinal  muscles.     The 
clavicles  were  both  down  and  backward  at  the  sternal  end;  there 
was  lesion  of  the  first  right  rib  and  of  the  second  left  rib;  also  a 
general  dropping  of  the  ribs  which  narrowed  the  chest  cavity. 
Lesion  affected  the  1st  and  2nd  lumbar,  and  the  pelvis  was  tilted. 
In  six  months  all  lesions  were  corrected,  and  the  case  showed 
marked  improvement. 

(3)  Palpitation   of  one  years  standing,   attending  physical 
or  mental  exertion.     Subluxation  of  the  fifth  rib  was  discovered. 


PRACTICE   OF    OSTEOPATHY.  231 

It  was  removed  in  one  treatment,  and  the  patient  suffered  no 
further  trouble. 

(4)  Palpitation  and  a  complication  of  diseases;  lesion  found 
at  the  atlas  and  in  the  upper  dorsal  spine.     No  palpitation  oc- 
curred after  the  third  treatment. 

(5)  Great  palpitation  of  the  heart,  due  to  marked  spinal 
curvature  in  the  upper  dorsal  and  cervical  regions,    came    upon 
the   patient   frequently.     Such   an   attack   was   usually   treated 
medically  with  digitalis  and  kept  the  patient  in  bed  for  several 
days.     Osteopathic    treatment    always   relieved    the   patient    of 
such  an  attack  in  a  few  minutes,  and  the  patient  could  go  about 
her  usual  duties.     It  was  a  common  occurrence  in  this  case  to 
slow  the  heart-beat  as  much  as  twenty  beats  per  minute,  this 
effect  not  being  transient,  but  lasting  for  several  days. 

(6)  Arrhythmia  and  a  general  bad  condition  of  the  health; 
lesion  of  the  4th  left  rib;  slight  lateral  lesion  of  the  fifth  lumbar 
vertebra.     The  latter  was  probably  responsible  for  uterine  trouble 
present,  which  may  have  influenced  the  heart.     After  two  months 
treatment  the  heart  beat  was  almost  normal. 

(7)  Arrhythmia,  in  which  the  patient  was  very  weak.     The 
left  5th  wras  down  upon  the  6th  and  slightly  inward.     The  cer- 
vical and  upper  thoracic  spinal  muscles  were  very  much  con- 
tracted.    The  treatment  was  directed  to  raising  the  rib  and  re- 
laxing the  contractured  muscles,  and  resulted  in  regulating  the 
heart-beat  in  six  weeks. 

(8)  Functional    weakness;    sinking    spells    occurred    upon 
any  exertion,  as  in  climbing  stairs.     The  left  thorax  was  found 
depressed;  the  left  clavicle  was  displaced  downward  at  its  sternal 
end,  while  it  was  up  and  forward  at  its  acromial  end.     All  the 
ribs  were  crowded  together.     Relief  followed  the  first  treatment, 
and  the  case  was  cured  in  five  weeks. 

(9)  Functional  weakness  of  the  heart,  due  to  a  downward 
displacement  of  the  right  fifth  rib  affecting  the  intercostal  nerve. 
The  case  was  cured  in  two  months. 

(10)  Impeded   heart-action,    resulting   from   a   fall   causing 
spinal  injury  and  nervous  shock.     The  marked  lesion  was  found 
at  the  atlas. 

(11)  Valvular  disease  of  12  years  standing  in  a  lady  aged  40. 


232  PRACTICE  OF  OSTEOPATHY. 

Marked  edema  of  limbs  and  abdomen  were  present.  She  was  suf- 
fering also  from  bronchial  asthma.  Lesions  were  contracture 
of  lower  cervical  and  upper  dorsal  muscles;  the  upper  ribs  were 
all  drawn  tight  tgoether,  under  treatment  the  asthma  and  dropsy 
were  cured,  and  the  whole  general  health  was  made  better  than 
for  years. 

(12)  Valvular  lesion  following  acute  rheumatism,  in  a  young 
man  of  23.     There  was  a  twist  in  the  spine  at  the  2nd  dorsal  and 
at  the  5th  dorsal.     Great  benefit  was  gotten  under  the  treatment. 

(13)  Enlargement  of  the  heart,   mitral  and   aortic  incom- 
petence, and  regurgitation ;  showed  lesion  in  forward  displacement 
of  the  atlas,  lesion  of  the  left  clavicle  and  upper  two  or  three  left 
ribs.     Three  treatments  produced  much  improvement,  one  months 
treatment  corrected  the  arrhythmia,    and  constant  improvement 
went  on  under  treatment. 

(14)  Angina   pectoris    after   lagrippe;    spinal    muscles    con- 
tractured;  the  3rd  to  5th  ribs  displaced  downward. 

(15)  Angina  pectoris  showing  lesion  of  the  2nd  to  5th  left 
ribs.     The  left  arm  could  not  be  raised  above  the  head  without 
extreme  pain.     Under   treatment   the   pains   became  gradually 
less  severe,  until  they  had  practically  ceased  at  the  end  of  two 
months. 

(16)  Angina   pectoris,    caused    by   downward   displacement 
of  the  left  clavicle,  and  cured  by  its  correction. 

(17)  Varicose  veins  and  milk  leg  of  fifteen  years  standing. 
The  tissues  surrounding  Hunter's  canal  and  the  saphenous  open- 
ing were  tense,   and   the  lumbar  vertebrae  were  anterior.     An 
operation  had  been  advised,  but  the  case  had  been  practically 
cured  under  osteopathic  treatment  at  the  time  of  the  report. 

(18)  Varicose  veins  of  eight  years  standing.     Three  varicose 
ulcers    were    discharging    when    treatment    began.     Innominate 
lesion  was  discovered.     The  case  was  cured  in  five  weeks. 

(19)  Varicose  veins,  for  which  operation  had     been  made 
without  success.     The  patient  was  compelled  to  sit  with  the  limb 
elevated,  and  had  been  thus  for  five  months.     The  physicians 
found  they  could  do  nothing  more,  and  recommended  continued 
elevation.     One  month  of  osteopathic  treatment  cured  the  case. 

(20)  Varicose    veins    of    two    years    standing.     Severe    and 


PRACTICE    OF    OSTEOPATHY.  233 

continuous  pain  in  the  limb  prevented  sleep.  The  muscles  over 
the  sacrum  and  the  lower  lumbar  vertebrae  were  rigid.  In  one 
month  of  treatment  the  case  showed  great  improvement. 

(21)  Varicose  ulcers  of  ten  years  standing  in  a  man  of  55. 
The  ulcers  extended  from  the  middle  of  each  leg  down  upon  the 
foot.     The  case  was  cured  in  three  months  by  opening  the  venous 
return  from  the  limb. 

(22)  Disturbed    circulation,    in    which    the    superficial    cap- 
illaries of  one  side  of  the  body  were  flushed,  reddening  the  skin, 
while  the  other  half  of  the  body  was  pale.     The  line  of  demarkation 
between   the   halves   of   the   body   was   very   prominent.     This 
trouble  had  come  upon  the  patient  as  the  direct  result  of  a  hard 
bicycle  ride.     Lesion  was  found  at  the  fifth  lumbar,  and  its  cor- 
rection cured  the  case. 

(23)  Disturbed   circulation.     The   patient   had   accidentally 
received  a  hard  blow  upon  the  head,  and  intense  pain  developed 
upon  one  side  of  the  head.     She  was  unable  to  turn  her  head 
without  turning  the  whole  body.     If  she  lay  upon  the  injured 
side  great  pain  followed.     This  condition  was  of  five  years  stand- 
ing.    Examination   showed    a    strong    contraction   of   the   deep 
muscles  of  the  neck,  which  set  up  irritation  of  the  local  sympa- 
thetic, affecting  the  vaso-constrictor  fibres  of  the  side  of  the  head 
in  question,  causing  over-contraction  of  the  vessels,  setting  up 
the  pain.     Treatment  was  directed  entirely  to  the  contractured 
muscles,  and  in  five  weeks  time  overcame  the  trouble  entirely. 

(24)  Circumscribed  ecchymosis  upon  the  left     wrist,  about 
the  diameter  of  a  five  cent  piece,  due  to  no  bruise  or  injury  to 
the  tissues  directly.     The  spot  was  drak,  nearly  black,  and  was 
allompanied  by  slight  numbness  in  the  forearm.     The  lesion  was 
a  slight  elevation  of  the  first  left  rib.     The  condition  seemed  to  be 
a  vaso-motor  effect  from  pressure  upon  the  brachial  plexus  or  by 
interference  with  the  spinal  sympathetic  connections.     Reduc- 
tion of  the  lesion  was  accomplished  at  one  treatment  and  had  an 
immediate  effect  upon  the  ecchymosis.     The  area  began  at  once 
to  grow  lighter  in  color,  and  in  ten  minutes  had  materially  changed. 
In  six  hours  it  had  disappeared. 

(25)  General  Dropsy,  ascites  being  quite  marked,  in  a  lady 
of  38,  and  of  2^  years  standing.     Lesions  occurred'  as  a  pos- 


234  PRACTICE    OF   OSTEOPATHY. 

terior  condition  of  the  third  dorsal,  and  a  separation  between  the 
fifth  lumbar  and  the  sacrum.  The  spinal  muscles  were  all  very 
tender.  The  case  was  cured.  The  treatment  was  almost  en- 
tirely upon  the  lesions,  with  some  general  spinal,  cervical  and 
thoracic  treatment  combined. 

LESIONS:  In  seeking  the  lesion  and  in  giving  the  treatment 
in  cardiac  diseases,  certain  centers,  prominently  connected  with 
the  normal  activities  and  pathological  manifestations  of  the  heart, 
must  be  specially  examined  for  lesion.  These  centers,  given  be- 
low, do  not  always  relate  to  specific  anatomical  or  physiological 
centers  of  the  texts,  but  in  some  cases  refer  to  bony  points  be- 
come prominent  in  osteopathic  work  as  locations  of  lesion  or  of 
places  where  treatment  produces  special  results.  These  are: 
the  first  rib  (heart  failure);  corpora  striata;  1st,  2nd,  3rd,  4th,  5th. 
dorsal  vertebrae ;  2nd  to  4th  dorsal  (valves  of  the  heart) ;  3rd  and 
4th  cervical  (rhythm  of  the  heart);  superior  cervical  ganglion 
(a  sympathetic  center) ;  upper  four  or  five  dorsal  nerves,  especially 
the  2nd  and  3rd  (accelerator  center);  medulla  (general  circula- 
tory). 

General  vaso-motor  centers  which,  with  the  special  vaso- 
motor  innervation  of  a  given  viscus,  suffer  from  lesion  in  circu- 
latory disturbances:  superior  cervical  ganglion;  2nd  dorsal,  5th 
lumbar,  for  general  superficial  capillary  circulation. 

The  lesions  usually  present  in  cardiac  diseases  are:  (1)  of 
the  atlas  and  axis;  (2)  the  cervical  region  generally,  both  mus- 
cular and  bony  lesion.  Lesions  of  the  atlas,  axis  and  cervical 
region  affect  the  superior  cervical  ganglion  and  the  other  sympa- 
thetic supply  of  the  heart.  (3)  Lesions  of  the  clavicle  are  found, 
as  are  those,  (4)  of  the  1st  rib,  (5)  of  the  2nd  rib,  (6)  of  the  upper 
six  ribs,  especially  on  the  left  side,  (7)  of  the  upper  five  dorsal 
vertebrae,  (8)  as  a  change  in  the  general  shape  of  the  thorax, 
(9)  of  the  fifth  left  rib  in  particular,  (10)  of  the  diaphragm,  i.  e., 
of  the  lower  six  ribs,  any  or  all  of  them,  and  of  certain  portions 
of  the  spine. 

Rib  lesions  are  of  prime  importance  in  such  diseases.  They 
seem  to  be  relatively  more  frequent  than  other  sorts,  perhaps  for 
the  reason  that  they  affect  the  heart  often  mechanically,  through 
alteration  of  the  chest  cavity,  as  well  as  by  interference  with  its. 


PRACTICE  OP  OSTEOPATHY.  235 

nerve-connections.  As  to  kind,  the  rib  lesion  is  as  important  as 
any  other  lesion,  while  as  to  frequency  it  is  of  greater  importance 
Many  of  the  rib  lesions  are  of  the  4th  and  5th  ribs,  either  or  both, 
and  usually  of  the  left  side.  Lesions  of  the  6th  rib,  significant 
with  relation  to  the  apex,  also  occur.  As  a  matter  of  fact,  le- 
sions of  these  two  are  the  most  important  of  the  rib  lesions.  They 
may  affect  both  nerve-connections  and  mechanical  relations  of  the 
heart.  The  fact  that  the  apex  beat  (falling  at  the  fifth  inter- 
space) may  be  interfered  with,  easily  deranging  the  whole  rhythm 
of  the  organ,  may  account  in  part  for  the  frequency  with  which  such 
lesion  causes  cardiac  disease.  In  numerous  cases  the  1st  and  2nd 
rib  present  lesion,  usually  on  the  left  side.  While  these  lesions 
are  not  so  generally  the  cause  of  heart  disease,  they  are  frequent 
and  important  lesions  in  these  cases.  Their  main  effect  is  through 
disturbance  of  the  nerve-connections.  The  first  rib  may  derange 
circulation  through  the  sub-clavian  vessels,  as  may  the  clavicle. 
In  some  cases  lesion  of  the  clavicle  occurs.  While  not  frequent, 
these  lesions  may  be  the  cause  of  serious  trouble. 

Spinal  lesions,  including  both  muscular  and  bony,  are  of  the 
greatest  importance  when  it  is  considered  that  rib  lesion  con- 
tributes to  them  by  disturbance  of  the  spinal  nerve-connections. 
They  act  by  producing  derangement  of  the  important  nerve- 
connections  in  the  upper  dorsal  region.  From  this  point  of  view, 
bony  and  muscular  lesions  in  the  cervical  region  become  signif- 
icant. While  not  so  frequently  the  sole  cause  of  heart  disease, 
they  yet  often  occur  and  derange  the  important  sympathetic 
connections  of  the  heart  and  this  region.  Lesions  of  the  atlas, 
axis,  or  of  any  of  the  first  three  or  four  cervical  vertebrae,  also  of 
the  rectus  capitis  anticus  major  muscle,  may  affect  the  superior 
cervical  ganglion  as  well  as  other  cervical  sympathetics. 

It  may  be  noted  that  practically  all  of  the  above  lesions 
affect  the  heart,  in  wrhole  or  in  part,  through  its  nerve-connec- 
tions. This  seems  to  be  the  most  important  avenue  over  w-hich 
abnormal  influences  travel  from  lesion  to  heart.  By  working 
directly  upon  nerve  distribution  to  the  heart,  irrespective  of  le- 
sion, important  changes  are  readily  made  in  its  activities.  Physi- 
ologically this  organ  is  markedly  affected  by  nervous  influences. 
It  seems  that  a  viscus  whose  nervous  equilibrium  is  so  readily 


236  PRACTICE  OF  OSTEOPATHY. 

disturbed  or  influenced,  should  be  peculiarly  susceptible  to  the 
influence  of  lesions  to  its  regulative  mechanism.  Such  lesions 
as  Osteopathy  considers,  affecting  this  mechanism  directly  as 
they  do,  must  be  the  true  cause  of  many  pathological  states. 
Their  removal  is  therefore  a  rational  means  of  cure. 

The  diaphragmatic  lesion  is  of  some  importance  in  heart 
diseases,  as  mentioned  above.  It  is  frequently  associated  with 
a  narrowed  thorax,  by  reason  of  increased  obliquity  of  the  ribs, 
as  well  as  of  various  other  lesions  of  them.  These  lesions  prevent 
free  rib  action,  meaning  also,  practically,  free  thoracic  play,  free 
diaphragmmatic  play,  and  free  circulation.  The  various  lesions 
which  impede  the  free  play  of  these  parts  must  unfavorably 
affect  circulation. 

In  the  cases  of  varicose  veins  reported,  the  importance  of 
lumbar,  sacral,  and  innominate  lesion  becomes  apparent,  also 
of  the  stoppage  of  venous  return.  Lesions  of  the  tissues  about 
the  saphenous  opening,  and  along  Hunter's  canal,  are  important 
in  this  connection.  Two  cases  of  vascular  disturbance  showed 
lesion  of  the  cervical  region  and  of  the  5th  lumbar  vertebra, it 
being  noticeable  that  each  came  at  a  place  at  which  it  could  af- 
fect the  center  for  superficial  circulation.  (Superior  cervical 
and  5th  lumbar). 

In  periods  from  one  or  a  few  treatments  to  three  months 
results  are  attained  in  long  standing  or  serious  cases  that  well 
demonstrate  the  superiority  of  osteopathic  therapeutics.  In  one 
case  the  pulse  was  reduced  from  140  to  110  at  the  first  treatment, 
and  was  kept  down  and  constantly  improved  thereafter.  In 
case  4  it  is  pointed  out  that  the  pulse  could  be  slowed  as  much  as 
twenty  beats  per  minute.  Considering  the  fact  that  a  cardiac 
medicine  that  reduces  the  heart  beat  one  per  minute  is  a  success- 
ful one,  it  is  readily  seen  that  osteopathic  control  of  the  heart  is 
most  successful. 

The  ANATOMICAL  RELATIONS  between  the  lesion  and  the 
heart-disease  are  made  clear  by  the  following  facts.  In  view 
of  them  it  seems  that  the  science  of  Osteopathy,  by  its  methods 
of  diagnosis,  arrives  at  the  real  cause  of  the  disease.  This  is 
true  also  with  reference  to  diseases  in  general. 

The   pneumogastric   nerves  and   the   sympathetics  are   the 


PRACTICE    OF   OSTEOPATHY.  237 

cardiac  nerves.  The  pneumogastric  is  the  heart  inhibitor,  and 
its  center  has  been  definitely  located  in  the  medulla.  It  is  a 
well-known  osteopathic  fact  that  lesion  in  the  superior  cervical 
region,  acting  through  the  superior  cervical  ganglion,  may  dis- 
turb the  centers  contained  in  the  medulla.  In  such  case  the 
heart  may  be  affected  by  disturbance  of  the  center  of  cardiac 
inhibition. 

Special  details  of  the  action  of  the  vagus  in  inhibiting  the 
heart  have  been  observed.  Strong  stimulation  of  the  nerve 
lengthens  both  systole  and  diastole,  i.  e.,  slows  the  beat.  It  also 
lessens  the  force  of  contraction,  and  causes  the  heart  to  beat  not 
only  more  slowly,  but  more  weakly.  At  the  same  time  this  stim- 
ulation results  in  the  heart  handling  less  blood,  as  the  output  and 
the  input  of  the  ventricle  are  both  diminished.  The  ventricular 
tonus  is  diminished,  and  the  heart  dilates  further  by  vagus  stim- 
ulation, while  at  the  same  time  the  walls  of  the  ventricle  have  been 
found  to  be  softer. 

Osteopathic  lesion  to  the  vagi  is  a  demonstrated  fact.  In 
view  of  the  above  functions  of  these  nerves,  it  becomes  at  once 
apparent  that  lesion  to  them  might  cause  serious  disturbance.  An 
irritative  lesion,  keeping  up  stimulation  of  the  nerve,  would  per- 
manently slow  the  beat,  lessen  cardiac  force,  retard  circulation, 
and  possibly  lead  to  dilated  and  flaccid  heart.  On  the  other 
hand,  should  the  lesion  be  of  a  nature  to  cut  off  or  to  inhibit  to  a 
degree  the  vagal  impulse  normally  retarding  the  heart  within 
limits,  the  accelerator  sympathetics  would  be  left  free  to  run  the 
heart  too  fast.  In  either  case  the  removal  of  the  lesion  to  the 
pneumogastric  would  be  of  prime  importance  in  curing  the  con- 
dition. Aside  from  removal  of  lesion,  osteopathic  treatment  of 
the  vagi  has  been  demonstrated  to  influence  heart  action.  The 
after  effect  of  vagus  stimulation  Gaskell  notes  to  be  increased 
force  of  cardiac  contraction.  This  is  an  indication  that  upon  re- 
moval of  lesion  Nature  would  make  special  effort  to  repair  the 
former  deficiency  of  function.  As  it  is  known  that  section  of 
the  vagus  is  followed  by  atrophy  of  the  cardiac  muscle,  it  would 
be  possible  that  serious  lesion  might  approximate  such  a  result. 

The  vagus  supplies  the  heart  by  its  upper  and  lower  cervical 
and  thoracic  cardiac  branches,  which  join  with  the  sympathetic 


238  PRACTICE    OF   OSTEOPATHY. 

and  go  to  the  cardiac  plexus.  It  also  has  connection  with  the 
superior  cervical  ganglion.  As  this  nerve  is  known  to  be  amenable 
to  osteopathic  treatment  at  many  points,  likewise  susceptible 
of  lesion  at  various  places,  as  at  the  atlas,  axis,  and  upper  dorsal 
via  its  sympathetic  connections,  along  the  sterno-mastoid  muscle 
and  at  the  clavicle,  its  importance  in  relation  to  the  cause  and  cure 
of  heart  disease  is  apparent. 

The  cardiac  depressor  nerve,  whose  presence  has  been  dem- 
onstrated in  man,  as  well  as  in  various  other  mammals,  retards 
heart  action  in  a  manner  different  from  that  of  the  vagus.  Its 
stimulative  impulses  come  from  the  heart  and  act  upon  its  sym- 
pathetic connections  with  the  splanchnics  to  produce  a  reflex 
vaso-dilatation  in  the  abdominal  vessels.  They  dilate  and  re- 
ceive a  large  amount  of  blood  from  the  general  system,  the  gen- 
eral blood  pressure  is  lessened,  arterial  tension  falls,  and  the 
heart  is  thus  quieted. 

It  is  thus  apparent  that  a  bony  lesion  in  the  splanchnic 
area  might  affect  the  spinal  connections  of  the  splanchnics,  pro- 
ducing an  inhibitor  effect  that  would  likewise  dilate  the  abdom- 
inal vessels,  and  slow  the  heart  by  a  process  similar  to  that  by 
which  the  heart  depressor  nerves  function. 

On  the  other  hand,  lesion  in  the  splanchnic  area  might  be 
of  a  nature  to  irritate  or  over-stimulate  the  sympathetic  connec- 
tions, thus  causing  a  constriction  of  the  abdominal  vessels,  and 
combating  the  normal  dilator  tendency  of  the  depressor  nerve, 
thus  preventing  the  heart  from  being  retarded  in  its  beat  to  a 
normal  degree. 

Hence  splanchnic  lesion  may  result  in  abnormal  slowness  or 
rapidity  of  the  heart,  and  this  condition  may  lead  to  other  cardiac 
disease.  These  facts  may  explain  Avhy  we  so  frequently  meet 
digestive  disturbances  and  the  like  in  heart  disease. 

A  further  fact  becomes  evident.  The  practical  Osteopath 
makes  much  use  of  the  splanchnic  and  abdominal  areas  in  his 
work  upon  cardiac  and  circulatory  disturbances.  By  inhibiting 
the  splanchnics,  and  by  an  inhibitive  or  relaxing  treatment  over 
the  abdomen,  he  dilates  the  vast  area  of  abdominal  vessels  and 
calls  the  blood  from  other  parts  of  the  body.  Reflexly  the  gen- 
eral blood-pressure  is  lessened,  arterial  tension  is  decreased  and 


PRACTICE    OF    OSTEOPATHY.  239 

the  heart  is  quieted.  On  the  other  hand,  stimulative  treatment 
to  splanchnics  and  abdomen  will,  by  the  opposite  effect,  increase 
arterial  tension  and  strengthen  cardiac  action. 

An  important  avenue  to  the  heart  is  through  the  cervical 
sympathetic  ganglia,  each  of  which  sends  a  cardiac  branch  to 
the  cardiac  plexus.  Between  these  branches,  the  branches  of 
the  vagus,  and  the  thoracic  sympathetic  there  are  numerous 
points  of  communication.  Each  ganglion  is  so  situated  and  so 
connected  with  the  spinal  nerves  that  it  is  susceptible  to  lesions. 
The  upper  ganglion  lies  in  front  of  the  second  and  third  cervical 
vertebrae  and  communicates  with  the  upper  four  cervical  nerves. 
It  may  suffer  from  lesion  of  the  upper  three  vertebrae.  Its  branch- 
es of  communication  with  the  3rd  and  4th  cervical  nerves  often 
pierce  the  rectus  capitis  anticus  major  muscle,  on  the  sheath  of 
which  the  ganglion  lies.  Contracture  of  this  muscle  may  act  as 
lesion  to  them.  The  middle  ganglion  lies  in  front  of  the  6th  and 
7th  cervical  vertebras  and  connects  with  the  5th  and  6th  cervical 
nerves.  The  lower  ganglion  lies  in  front  of  the  1st  costo-verte- 
bral  articulation,  and  connects  with  the  7th  and  8th  cervical 
nerves.  They  are  susceptible  to  lesion  respectively  of  the  5th, 
6th,  and  7th  cervical  vertebrae  and  the  1st  rib.  All  three  are 
liable  to  muscular  lesion  in  cardiac  disease. 

The  accelerator  or  augmentor  nerves  of  the  heart  are  sym- 
pathetic. They  are  antagonistic  to  the  vagi.  That  they  are 
liable  to  suffer  from  spinal  lesion  is  at  once  apparent  from  their 
anatomical  relations.  They  are  derived  from  the  upper  four  or 
five  dorsal  nerves,  especially  from  the  2nd  and  3rd.  They  join 
the  sympathetic  at  the  middle  and  lower  cervical,  perhaps  also 
first  thoracic,  ganglia.  (Quain).  The  most  important  treat- 
ments for  cardiac  stimulation  or  inhibition  are  made  in  the  upper 
dorsal  region,  at  the  origin  of  these  nerves,  by  stimulation  or 
inhibition  of  them.  Important  heart  lesions  occur  in  the  upper 
dorsal  region  (spine  or  rib)  and  probably  affect  the  heart  through 
these  connections.  The  connection  of  these  ganglia  with  the 
middle  and  inferior  cervical  ganglia  lends  the  latter  added  im- 
portance in  these  matters. 

When  these  accelerators  are  stimulated,  they  increase  the 
frequency  of  the  heart-beat  from  7  to  70  per  cent,  but  a  long 


240  PRACTICE   OF   OSTEOPATHY. 

stimulation  produces  no  greater  acceleration  than  a  short  one. 
This  marked  increase  in  the  pulse  is  quickly  apparent  under  os- 
teopathic  stimulation  of  the  accelerators.  Further  results  of 
stimulating  them  are  an  increased  force  of  the  ventricular  beat, 
the  ventricles  are  more  completely  filled  by  the  auricles  and  their 
volume  is  increased.  The  strength  and  volume  of  the  auricular 
contractions  are  also  increased.  Hence  our  treatment  both 
quickens  and  invigorates  the  heart  muscle,  and  the  organ  conse- 
quently handles  more  blood  at  a  beat. 

Lesions  of  the  lower  cervical,  upper  dorsal,  or  upper  thoracic 
(rib)  region  might  be  of  such  a  nature  as  to  maintain  continual 
stimulation  of  the  accelerators,  lead  to  permanently  quickened 
and  strengthened  heart-beat,  and  produce  such  an  affect  as  hyper_ 
trophy  of  the  heart.  Or  the  lesion  might  cut  off  or  lessen  the 
accelerator  impulse,  leading  to  abnormally  slow  heart-beat,  lack 
of  strength  of  heart  action,  etc.  Hence  the  importance  of  cor- 
recting lesion  in  these  regions. 

Jacobson  (in  Hilton's  "Rest  and  Pain")  points  out  that 
the  cardiac  plexus  through  the  aortic  plexus,  is  connected  with 
the  4th,  5th  and  6th.  spinal  nerves.  This  fact  may  in  part  ex- 
plain the  importance  of  lesion  of  the  4th  and  5th  ribs  in  heart 
disease.  The  1st,  2nd  and  3id  spinal  nerves,  through  the  sym- 
pathetic, supply  sensory  fibres  to  the  heart.  (Quain).  The 
above  facts  explain  why  secondary  lesion  as  contractured  muscles 
may  occur  along  the  upper  dorsal  spine  as  far  as  the  6th  in  cardiac 
disease. 

The  cardiac  plexus  is  made  up  of  the  cardiac  branches  of  the 
vagus  and  from  the  cervical  ganglia,  whose  functions  and  rela- 
tions to  cardiac  disease  were  pointed  out  above.  This  plexus 
suffers  from  lesion  of  those  nerves,  and  is  the  medium  through 
which  lesion  acts  upon  the  heart.  The  right  and  left  coronary 
plexuses,  derived  from  the  cardiac,  supply  the  coronary  arteries. 
Lesion  to  them,  through  the  cardiac,  would  influence  nutrition 
and  circulation  in  the  heart  substance. 

The  intercostal  nerves  may  become  important  paths  of 
transmission  of  the  effects  of  lesion  to  the  heart.  It  is  well  known 
that  rib  lesions  are  among  the  most  frequent  causes  of  heart- 
disease.  Possibly  much  of  their  influence  is  by  irritation  to  the 


PRACTICE    OF   OSTEOPATHY.  241 

intercostal  nerves.  These  nerves  are  the  anterior  primary  branches 
of  the  spinal  nerves,  and  the  ramus  communicans  from  each 
thoracic  sympathetic  ganglion  passes  directly  to  the  intercostal 
nerve  corresponding.  As  shown  above,  the  heart  is  in  connec- 
tion with  the  upper  six  dorsal  nerves  through  its  sympathetic 
sppply.  The  upper  four  or  five  give  origin  to  the  accelerators. 
The  1st,  2nd  and  3rd  contribute  sensory  branches  to  the  heart. 
The  4th,  5th  and  6th  connect -with  the  cardiac  plexus  through 
the  aortic.  Hence,  on  account  of  this  direct  connection  between 
heart  and  the  anterior  primary  divisions  of  the  upper  six  dorsal 
nerves  the  immediate  effect  of  lesion  in  this  portion  of  the  thorax 
might  be  upon  the  heart.  Hence  the  importance  of  luxated  ribs, 
sore  and  contractured  intercostal  muscles,  a  narrowed  chest  and 
changed  shape  of  the  thorax.  These  facts  emphasize  the  im- 
portance of  free  thoracic  play  in  the  maintenance  of  the  health 
of  the  thoracic  viscera. 

A  general  changed  shape  of  the  thorax  may  have  its  bear- 
ing upon  the  etiology  of  cardiac  trouble  in  other  ways.  The 
total  intercostal  circulation  represents  a  considerable  portion  of 
the  general  circulation.  If  this  whole  circulation  be  obstructed, 
as  may  occur  in  those  conditions  in  which  a  general  alteration 
in  the  shape  of  the  thorax  has  produced  narrowing  of  the  inter- 
costal spaces,  the  heart  must  be  put  to  greater  exertion  to  force 
the  blood  through  this  area  of  obstructed  vessels.  Furthermore, 
such  a  condition  of  narrowed  thorax  is  just  the  one  pointed  out 
as  the  cause  of  lesion  to  the  diaphragm,  which  obstructs  the  flow 
of  blood  through  the  aorta  and  still  further  embarrasses  the  heart. 
Take  these  obstructions  to  intercostal  and  aortic  circulation  in 
conjunction  with  rib  lesions  to  intercostal  nerves,  a  frequent^oc- 
currence,  and  it  could  hardly  result  otherwise  than  that  cardiac 
derangement  must  follow. 

The  phrenic  nerve  innervates  both  heart  and  diaphragm. 
Lesion  to  it  may  affect  this  organ,  or  treatment  of  it  may  aid 
in  cardiac  cases.  It  is  joined  by  branches  from  the  middle  or 
lower  cervical  sympathetic  ganglia  and  from  the  thoracic  sym- 
pathetic, both  of  which  are  connected  with  the  heart  innerva- 
tion.  It  perforates  the  diaphragm  and  joins  the  abdominal  sym- 
pathetic. It  supplies  the  right  pericardium,  the  right  auricle, 

16 


242  PRACTICE   OF    OSTEOPATHY. 

and  the  inferior  vena  cava.  Perhaps  it,  a  motor  nerve,  co-ordi- 
nates the  activities  of  heart  and  diaphragm,  so  closely  related  in 
function.  Its  inhibition  is  our  common  method  of  relaxing  the 
diaphragm  in  hiccough. 

Its  inhibition  would  be  important  in  securing  a  lax  or  quiet 
diaphragm,  so  desirable  in  the  treatment  of  certain  forms  of 
cardiac  diseases,  the  more  so  as  it  may  likely  be  suffering  from 
the  irritation  of  the  disease  affecting  the  heart  or  its  coverings. 

Clavicular  lesion  may  affect  the  subclavian  vessels,  dam 
back  the  flow  of  blood  through  the  artery,  or,  by  preventing  the 
return  flow  through  the  vein,  cause  the  periodic  loss  of  a  heart- 
beat through  insufficient  filling  of  the  organ. 

The  intimate  relations  between  the  cardiac  nerves  and  the 
general  nervous  system  is  seen  in  the  fact  that  stimulation  of  the 
sciatic  increases  the  force  and  frequency  of  the  heart-beat.  These 
facts  are  of  value  hi  treatment  for  the  general  circulation. 

PERICARDITIS. 

Under  osteopathic  treatment  the  prognosis  for  cure  is  good 
in  the  dry  or  plastic  form  and  in  that  with  serous  effusion.  In 
the  purulent  form,  and  in  chronic  adhesive  pericarditis  the  prog- 
nosis must  be  unfavorable,  though  much  might  be  done  to  bene- 
fit the  patient's  condition. 

The  LESIONS  affect  the  blood-supply  by  derangement  of 
the  spinal  sympathetics.  Irritative  rib  lesions,  bringing  pressure 
directly  upon  the  heart,  cause  the  disease  by  mechanical  irrita- 
tion of  the  pericardium.  This  is  especially  likely  to  occur  in 
lesion  to  the  fourth  and  fifth  left  ribs,  they  occurring  at  the  site 
of  apex  beat,  where  the  greater  range  of  motion  is  more  likely 
to  be  interfered  with  by  narrowing  of  the  thoracic  cavity  or  by 
inward  displacement  of  these  ribs.  Lesions  to  the  subclavian 
vein  at  the  first  rib  or  clavicle,  and  to  the  anterior  intercostal 
vessels,  preventing  venous  drainage  of  the  pericardium,  may 
predispose  to  the  condition.  A  narrowed  thorax  and  a  deranged 
diaphragm  may,  by  pressure  or  traction  upon  the  pericardium, 
allow  special  causes  to  set  up  irritation  and  inflammation  in  the 
structure.  These  various  lesions  may  lay  the  foundation  for  the 
disease,  some  special  active  cause  producing  it  directly.  Thus 


PRACTICE    OF    OSTEOPATHY.  243 

spinal  and  other  lesion  to  the  cardiac  nerves  weakens  the  tissues 
and  lays  them  liable  to  the  effect  of  such  disorders  as  rheumatism, 
gout,  scarlatina,  influenza,  etc.,  secondarily  to  which  pericarditis 
occurs.  In  such  cases  also  attention  must  be  given  to  the  lesion 
accountable  for  the  primary  disease. 

In  the  TREATMENT  the  patient  must  be  kept  at  rest  in  the 
recumbent  position  to  aid  in  slowing  the  beat  of  the  heart.  This 
object  is  directly  accomplished  by  stimulation  of  the  vagus  and 
inhibition  of  the  accelerators.  The  former  is  treated  by  manip- 
ulation along  its  course  behind  the  sterno-mastoid  muscle.  In- 
hibition of  the  accelerators  is  applied  along  the  spine  from  the  6th 
cervical  to  the  5th  dorsal.  With  the  patient  lying  upon  his  back 
the  left  arm  is  raised  and  held  well  above  and  behind  the  head, 
while  steady  pressure  is  applied  along  the  upper  dorsal  region  as 
far  down  as  the  fifth  vertebra.  ' 

The  lesion  must  be  removed.  The  ribs  may  be  carefully 
raised  to  free  the  venous  circulation  through  the  internal  mam- 
mary veins,  which  drain  the  anterior  intercostal  veins.  This 
aids  in  allaying  the  inflammation,  as  does  also  the  inhibitive 
abdominal  treatment  by  drawing  the  blood  to  the  abdomen. 
The  latter  operation  is  assisted  by  inhibition  along  the  splanch- 
nics  at  the  spine.  Calling  the  blood  to  the  abdomen  not  only 
aids  in  allaying  the  inflammation,  but  may' slow  the  heart  by 
decreasing  arterial  tension.  As  this  reflex  dilatation  of  the  ab- 
dominal veins  is  a  result  the  same  as  that  produced  by  the  heart 
depressor  nerve  in  functioning  to  quiet  the  heart,  it  is  supposable 
that  treatment  given  to  dilate  these  vessels  produces  a  result 
similar  to  that  resulting  from  depressor  nerve  action. 

As  all  the  ribs  are  carefully  raised  to  expand  the  thorax 
and  give  freedom  to  the  heart,  the  various  intercostal .  muscles 
should  be  gently  manipulated  and  relaxed.  On  account  of  the 
close  connection  pointed  out  above  between  the  intercostal 
nerves  and  the  sympathetics  connected  with  the  heart,  it  is 
probable  that  reflex  sensations  are  transmitted  from  the  dis- 
eased cardiac  apparatus  to  the  intercostal  nerves,  leading  to  a 
contractured  condition  of  the  intercostal  muscles  generally. 

The  phrenic  nerves  should  be  inhibited  to  relax  the  dia- 
phragm (and  pericardium  (?)  which  it  supplies).  This  treat- 


244  PRACTICE    OF   OSTEOPATHY. 

ment  is  the  more  important  in  pericarditis,  as  the  diaphragm 
is  probably  irritated  by  the  inflammation  in  the  pericardium 
directly  contiguous  to  it.  Irritation  would  mean  contracture. 
This  relaxation  of  the  diaphragm  would  aid  in  quieting  the  heart 
and  in  relieving  the  whole  local  condition.  The  desirability  of 
securing  a  lax  state  of  diaphragm  and  pericardium  in  the  treat- 
ment of  pericarditis  is  suggested  by  Hilton. 

The  pain  about  the  heart  is  lessened  by  the  whole  treat- 
ment. Direct  treatment  may  be  made  for  it  by  inhibition  of 
the  1st,  2nd,  and  3rd  dorsal  nerves  (sensory  to  the  heart),  and 
the  4th,  5th,  and  6th  dorsal  nerves,  which  apparently  convey 
sensory  impressions  from  the  heart. 

The  dyspnea  is  relieved  by  the  allaying  of  the  inflammation, 
quieting  the  heart,  and  raising  of  all  the  ribs.  Effusion  is  pre- 
vented or  resorbed  by  keeping  up  free  circulation,  especially 
after  the  acute  stage  for  the  latter  object.  If  necessary,  the  ice- 
bag  may  be  applied  to  the  precordial  region  to  allay  the  inflam- 
mation. Its  use  may  become  necessary  in  the  intervals  between 
treatment.  The  diet  should  be  of  milk  and  broths  during  the 
acute  stage.  Later  ,it  should  be  light. 

Treatment  should  be  given  daily.  More  than  one  treatment 
per  diem  may  be  necessary,  especially  attention  to  various  phases. 

Treatment  for  the  various  forms  of  pericarditis  would  be 
upon  the  same  plan,  with  due  attention  to  the  manifestations 
of  each  condition.  In  the  chronic  form  it  would  be  proper  to 
keep  the  heart  well  stimulated,  to  increase  its  nutrition.  The 
patient  should  take  plenty  of  rest  lying  down  to  avoid  hyper- 
trophy of  the  heart.  For  the  plastic  form  and  for  that  with 
serous  effusion,'  the  treatment  is  as  above  described.  In  the 
latter,  during  the  stage  of  effusion  one  must  carefully  watch  the 
heart  to  prevent  collapse.  When  the  pulse  becomes  weak,  and 
cyanosis  is  present,  the  heart  and  lungs  should  both  be  stimu- 
lated. In  the  purulent  form  the  treatment  should  be  applied 
as  above,  but  this  condition  calls  for  surgical  treatment.  The 
pericardial  sac  should  be  drained. 

HYDROPERICARDIUM  is  a  condition  in  which  a  serous  fluid 
transudate  occupies  the  pericardial  sac.  but  no  inflammatory 
condition  is  present.  It  is  commonly  associated  with  renal  or 


PRACTICE    OF    OSTEOPATHY.  245 

cardiac  dropsy,  and  its  treatment  is  that  indicated  for  them,  q.  v. 
PNEUMOPERICARDIUM  calls  for  palliative  treatment  similar 
to  that  described  for  pericarditis  with  effusion.  The  heart  should 
be  kept  stimulated  against  collapse.  The  case  calls  for  surgical 
treatment. 

PALPITATION. 

DEFINITION:  A  paroxysmal  rapidity  of  heart-action,  per- 
ceptible to  the  patient,  and  usually  accompanied  by  increased 
force,  disturbed  rhythm,  precordial  distress,  anxiety,  and  dyspnea. 
This  condition  is  caused  by  special  lesion,  usually  a  bony  one, 
that  interferes  with  the  nerve-mechanism  or  with  the  heart 
mechanically.  This,  and  the  so-called  neuroses  of  the  heart, 
are,  from  the  osteopathic  standpoint,  neuroses  mainly  because  of 
their  being  caused  by  disturbed  nerve-mechanism  of  the  organ. 
This  is  no  more  nor  less  true  in  such  diseases  than  in  the  general 
diseases  of  the  heart. 

LESIONS  AND  ANATOMICAL  RELATIONS  have  been  discussed 
in  a  general  way  above.  An  examination  of  the  several  cases 
of  palpitation  reported  at  the  beginning  of  the  chapter  shows 
a  wide  range  of  lesion,  namely,  from  the  atlas  to  the  last  rib, 
when  considering  as  a  lesion  producing  this  condition  those 
changes  in  the  shape  of  the  thorax  and  those  lesions  of  the  lower 
six  ribs  responsible  for  lesion  of  the  diaphragm  embarrassing  the 
heart.  These  lesions  may  act  by  disturbing  the  nerve-connec- 
tions of  the  heart,  by  occluding  certain  vascular  areas  or  single 
vessels,  or  by  direct  mechanical  pressure  upon  the  heart.  Le- 
sions of  the  clavicle  and  first  rib  are  frequent,  and  they,  by  dam- 
ming back  the  blood  in  the  sub-clavian  artery,  may  cause  periods 
of  labored  beat  of  the  heart  to  force  it  through.  Or  by  lessening 
venous  flow  from  the  sub-clavian  vein  such  lesion  ma"y  cause 
a  paroxysm  of  rapid  beating  of  the  heart  in  the  endeavor  to  fill 
itself.  Cervical  and  upper  dorsal  lesions,  curvatures  of  the  upper 
spine,  lesions  of  the  upper  five  ribs,  and  general  contracture  of 
the  spinal  muscles  may  all  act  as  irritant  upon  the  accelerator 
sympathetics,  noted  as  rising  from  the  upper  four  or  five  dorsal 
nerves  and  passing  to  the  middle  and  lower  cervical  sympathetic 
ganglia.  Stimulation  of  these  accelerators  thus  caused  could 


246  PRACTICE    OF    OSTEOPATHY. 

produce  the  rapid  beating  of  the  heart  found  in  palpitation.  This 
class  of  lesion  is  most  frequent  in  these  cases. 

Atlas  lesion  may  affect  the  heart  through  the  superior  cer- 
vical ganglion  and  its  upper  cardiac  branch.  But  through  this 
ganglion  such  lesion  is  able  to  affect  the  inhibitory  center  in  the 
medulla,  or  it  may  affect  the  vagus  itself  by  way  of  its  sympathetic 
connections  with  the  ganglion  mentioned.  The  result  is  over- 
activity  of  the  inhibitor  function  of  the  vagus,  and  the  rapid  beat 
thus  allowed  as  the  result  of  unapposed  activity  of  the  accelerator. 
This  style  of  lesion  is  not  a  frequent  cause  of  palpitation. 

It  may  be  argued  that  as  bony  lesions  are  by  nature  con- 
tinuous, the  paroxysmal  rapidity  of  the  heart  in  palpitation  could 
not  be  thus  caused,  that  the  effect  of  this  continuous  lesion  must 
itself  be  continuous  as  opposed  to  paroxysmal.  Such  is  not  the 
case,  however.  The  lesion  may  not  be  so  excessive  in  degree  as 
to  keep  up  continual  irritation.  Its  irritation  may  become  active 
only  in  certain  motions  or  postures  of  the  affected  parts.  It 
may  be  the  neuropathic  basis  weakening  the  nerve  tissues  and 
laying  the  heart  liable  to  the  effects  of  special  emotions,  stimu- 
lants, .etc.  The  lesion  might  even,  per  se,  be  of  a  nature  to  cause 
continuous  irritation  and  yet  its  effects  not  be  continually  ap- 
parent as  rapid  heart-beat  on  account  of  the  natural  variation  in 
the  activity  of  the  accelerator  centers  and  in  the  condition  of  the 
nervous  system. 

Luxation  of  the  fifth  left  rib  mechanically  irritates  the  heart 
and  causes  palpitation.  Occuring  as  it  does  at  the  site  of  the 
apex-beat,  it  is  just  as  likely  a  cause  of  palpitation  as  is  the 
pressure  from  a  stomach  dilated  with  gas.  Displacement  of  this 
rib  and  of  the  4th  is  a  common  cause  of  palpitation.  Rib  lesions 
in  general  are  quite  apt  to  be  found  in  cases  in  which  palpitation 
is  brought  on  by  slight  muscular  exertion.  The  movable  rib, 
being  luxated,  is  readily  thrown  into  an  exaggerated  condition 
of  lesion  upon  muscular  effort.  Cases  are  continually  met  in 
which  some  special  form  of  muscular  activity,  perhaps  necessitated 
by  the  patient's  occupation,  has  first  caused  the  displacement 
and  has  then  become  the  repeatedly-acting  cause  of  the  various 
attacks  of  palpitation  which  have  followed. 

A  frequent  and  serious  cause  of  heart  disease  in  general, 


PRACTICE    OF    OSTEOPATHY.  247 

at?  well  as  of  palpitation  in  particular,  is  found  in  a  general  down- 
ward luxation  of  the  ribs  resulting  in  a  narrowed  thorax.  Such 
a  condition  becomes  a  three-fold  lesion.  Looked  at  as  the  cause 
of  palpitation  it  acts:  (1)  By  partially  occluding  the  calibre  of 
the  arteries  in  the  total  intercostal  area,  aggregating  a  considerable 
vascular  total.  (2)  By  causing  lesion  to  the  diaphragm  of  a 
nature  allowing  it  to  constrict  the  aorta.  As  a  result  of  all  this 
arterial  obstruction  the  heart  labors  (palpitation)  to  force  the 
blood  along  its  accustomed  channels.  (3)  By  irritation  to  the 
intercostal  nerves  in  the  narrowed  intercostal  spaces.  The  upper 
six  of  these  nerves,  as  above  explained,  are  in  direct  sympathetic 
connection  writh  the  heart  and  convey  to  it  the  irritation  engen- 
dered in  the  intercostal  spaces,  causing  it  to  palpitate. 

It  will  be  noted  that  chronic  heart  sufferers  are  very  often 
the  possessors  of  flat  chests  and  narrowed  thoraxes. 

Dyspepsia,  flatulence  and  diseased  abdominal  organs  often 
reflexly  set  up  palpitation.  It  may  be  that  both  effects  are  the 
results  of  a  common  lesion,  i.  e.,  one  to  the  splanchnic  nerves 
(abdominally  or  spmally).  It  has  been  explained  that  the  de- 
pressor nerve  of  the  heart  acts  reflexly  through  the  splanchnics 
to  produce  vaso-dilatation  in  the  great  abdominal  vascular  area, 
"bleeding  the  patient  into  his  own  venis,"  and  to  cause  a  fall 
of  blood-pressure,  with  a  quieting  of  the  heart.  On  the  other 
hand,  splanchnic  lesion  may  set  up  intense  vaso-constriction  in 
this  area,  oppose  the  circulation  of  the  blood  in  this  way,  and  cause 
the  labored  beat  or  palpitation  of  the  heart  to  force  the  blood 
through. 

The  common  cause  assigned  for  palpitation,  such  as  a  strong 
emotion,  the  use  of  tea,  coffee,  tobacco,  and  alcohol;  reflex  dis- 
turbances from  the  ovaries,  uterus,  and  other  pelvic  organs,  etc., 
seem  to  be  but  incidental.  There  must  be  some  cause  determining 
the  effects  of  these  agents  upon  the  heart.  Otherwise  it  is  hard 
to  explain  why  these  things  effect  one  patient's  heart  and  not 
that  of  another.  The  real  cause  weakening  the  heart  and  allow- 
ing these  incidental  causes  to  disturb  it  lies  in  the  anatomical 
weak  point  affecting  the  organ  or  its  connections.  A  multitude 
of  cases  cured  by  replacement  of  a  displaced  rib,  or  the  like,  leads 
to  the  conclusion  that  these  so-called  causes  had  little  to  do  with 


248  PRACTICE    OF    OSTEOPATHY. 

the  real  cause ;  as  of  case  6  above,  in  which  three  weeks  treatment 
cured  palpitation  of  many  years  standing,  and  rendered  the  patient 
immune  to  the  effects  of  coffee  and  tobacco,  which  before  he  could 
not  use. 

In  cases  where  the  palpitation  is  purely  secondary,  as  in 
anemia,  from  the  changed  state  of  the  blood,  and  in  acute  infectious 
diseases,  from  the  irritation  of  toxic  substances  circulating  in 
the  blood,  the  lesions  belong  to  the  primary  disease. 

The  PROGNOSIS  is  good.  The  most  marked  and  long  stand- 
ing cases  have  yielded  readily  to  treatment.  The  case  is  gen- 
erally relieved  at  once  and  soon  cured. 

The  TREATMENT  of  the  time  of  attack  must  look  at  once  to 
quieting  the  nerve  irritation  that  is  causing  the  trouble.  (1) 
Often  the  immediate  removal  of  the  lesion  is  practicable  and  is 
the  sole  treatment  necessary. 

(2)  Inhibition  of  the  accelerators  in  the  manner  described 
in  detail  in  the  previous  pages  is  the  most  efficient  method  of 
at  once  relieving  the  palpitation.     Considerable  pressure  may  be 
applied  to  the  accelerator  area  of  the  spine,  the  left  arm  mean- 
while  being   strongly   held   above   the   head    (see   Pericarditis). 
Steady  pressure  at  each  point  along  these  nerves  for  several  min- 
utes is  necessary.     During  this  treatment  one  hand  is  slipped 
beneath  the  "patient,  the  arm  may  be  held  down  above  the  head 
against  the  table  by  the  pressure  of  the  practitioner's  trunk  against 
it,  while  with  his  hand  he  relaxes  the  intercostal  tissues  all  about 
the  precordial  region.     This  is  to  release  contractions  in  the  in- 
tercostal muscles  set  up  by  the  irritation  carried  from  the  cardiac 
plexus  to  the  upper  intercostal  nerves,  with  which  it  is  closely 
connected. 

(3)  Stimulation  of  the  pneumogastric  nerves  in  the  neck 
aids  inhibition  of  the  heart-action  (IV,  Chap.  IV).     "Pressure 
upon  the  vagus  in  the  neck,  or  pressure  upon  special  points  in 
the  abdominal  parieties,  (the  ovarian  region  in  particular)  some- 
times arrests  the  attack  promptly"  (Anders). 

(4)  Stimulation  of  the  abdominal  sympathetics,  by  a  quick 
treatment,  will  aid  in  inhibiting  the  heart  beat.     A  better  method, 
however,  is  to  dilate  the  vast  abdominal  vascular  system  by  the 
deep,   inhibitive  abdominal   treatment.     This   drains  the  blood 


\ 

PHACTICE    OF    OSTEOPATHY.  249 

into  the  abdomen,  decreases  general  arterial  tension,  and  quiets 
the  heart.  It  is  the  exact  process  by  which  the  depressor  nerve 
quiets  the  heart,  and  may  possibly  cause  it  to  function.  Strong 
inhibition  of  the  spinal  splanchnics  aids-  this  process. 

(5)  All  the  ribs  should  be  carefully  elevated  to  allow  free 
play  to  respiration  and  heart.     The  dyspnea  is  a  reflex  from  the 
•disturbed  heart.     It  is  relieved  by  this  treatment,  and  by  the  re- 
lieving of  the  heart. 

(6)  Other  sources  of  irritation,   as  anemia,   pelvic  disease, 
etc.,  call  for  special  treatment. 

(7)  Upon  the  attack  the  patient  should  be  laid  upon  his 
back  at  once,  and  the  clothing  about  the  neck  and  chest  should 
be   loosened.     Treatment    (2)    should   be   at    once   applied.     In 
case  of  necessity  during  the  practitioner's  absence,  an  ice-bag 
applied  to  the  precordial  region  is    a     good    domestic    remedy. 
The   patient   may  swallow  bits  of  ice  or  drink  plentifully  of  cold 
water.    Hot  and  somewhat  stimulating  drinks  are  recommended. 

If  the  attacks  are  frequent  or  persistent  the  treatment  must 
be  often  given.  In  treatment  to  prevent  the  recurrence  of  at- 
tacks a  course  of  treatment  may  be  carried  out  along  the  lines 
laid  down.  Special  attention  would  naturally  be  given  the  le- 
gion. t  Heart  action  and  circulation  would  be  built  up,  etc.  At- 
tention should  be  given  to  the  diet,  as  certain  articles  of  diet  may 
•cause  palpitation.  An  overloaded  stomach  should  be  relieved  by 
vomiting. 

TACHYCARDIA,    BRACHYCARDIA    AND    ARRHYTHMIA. 

The  first  is  a  rapid  beating  of  the  heart  in  paroxysms  of 
variable  duration,  unaccompanied  by  any  marked  subjective 
sensations.  The  second  is  an  abnormal  slowness  of  the  heart, 
temporary  or  permanent.  The  third  is  irregular  beating  of  the 
heart,  the  irregularity  being  manifest  in  volume,  force  or  time, 
.alone,  or  in  various  combinations,  presenting  various  peculiarities. 

The  lesion  and  its  mode  of  causing  disease,  described  for 
palpitation,  are  essentially  the  same  for  these  three  manifesta- 
tions of  disturbance  to  the  cardiac  mechanism.  The  treatment, 
also,  would  proceed  along  the  same  general  lines  there  laid  down, 
being  varied"  to  suit  the  requirements  of  the  disease  and  of  the 


250  PRACTICE    OF   OSTEOPATHY. 

individual  case.  As  a  matter  of  fact  the  lesions  found  as  the 
actual  causes  of  these  different  diseases  are  practically  the  same 
in  kind,  affect  the  same  areas,  nerve  connections,  and  vascular 
relations,  but  differ  in  degree,  in  concentration  upon  a  particular 
region,  e.  g.,  chiefly  upon  the  accelerators  in  the  upper  region  to 
produce  tachycardia,  and  therefore  in  the  particular  manifesta- 
tion or  results  of  their  presence. 

It  is  natural  that  those  lesions  producing  palpitation  should 
be  greater  in  degree  and  more  continuous  and  severe  in  action, 
thus  producing  tachycardia;  that  upper  dorsal  lesion  should  so 
excessively  affect  the  accelerators  as  to  permanently  inhibit 
their  activity  to  a  degree  great  enough  to  cause  brachycardia, 
or  that  the  periodic  or  irregular  manifestations  of  the  effects  of 
such  lesion  should  produce  arrhythmia.  The  latter  is  generally 
a  feature  of  ordinary  palpitation.  In  the  same  way  arterial, 
venous,  or  other  nerve  lesion  might  become  the  cause  of  either 
disease.  In  other  words,  a  purely  osteopathic  classification  of 
diseases  would  regard  these  conditions  as  essentially  the  same, 
both  as  to  lesion  and  as  to  general  manner  'of  treatment. 

One  must  bear  ip.  mind  the  fact  that  these  conditions  are 
frequently  simply  symptomatic,  as,  for  example,  the  arrhythmia 
resulting  fiom  reflexes  from  kidneys,  lungs,  liver  or  stomach,  or 
from  the  toxic  effects  of  tea,  coffee,  tobacco,  alcohol,  or  drugs. 
But  they  may  also  be  due  to  cardiac  changes  in  the  ganglia,  or 
in  the  walls,  such  as  simple  dilatation,  fatty  degeneration,  or 
sclerosis. 

The  fact  that  tachycardia  is  looked  upon  as  being  a  mani- 
festation of  paralysis  of  the  pneumogastric  or  stimulation  of  the 
sympathetic  is  significant  from  the  osteopathic  viewpoint. 

The  prognosis  for  these  conditions  is  ordinarily  good.  The 
results  attained  are  very  satisfactory  and  cases  are  often  readily 
cured.  The  fact  that  they  are  frequently  symptomatic  of  other 
disease,  or  secondary  thereto,  makes  the  prognosis  and  treat- 
ment depend  upon  the  primary  condition.  When,  as  is  often  the 
case,  they  are  found  to  depend  upon  specific  removable  lesion 
the  progress  is  good.  It  is  not  good  when  organic  heart  disease 
is  present. 

The  treatment  for  these  conditions  must  be  primarily  the 


PRACTICE    OF    OSTEOPATHY.  251 

removal  of  lesion  or  irritating  cause,  or  the  treatment  of  the  pri- 
mary disease  to  which  either  may  be  secondary  or  symptomatic. 
All  causes  of  reflex  irritation,  and  the  abuse  of  tea,  coffee,  and 
alcohol,  etc.,  must  be  looked  to.  That  for  tachycardia  and 
arrhythmia  is  practically  that  for  palpitation.  The  treatment 
for  brachycardia  is  mainly  stimulation  of  the  accelerators.  In 
the  treatment  of  brachycardia  or  the  tachycardia  following  acute 
infectious  diseases,  e.  g.,  typhoid  fever,  the  excertory  organs 
must  be  stimulated  to  free  the  system  of  poison,  and  the  centers 
controlling  the  activities  of  the  heart  must  be  built  up,  as  they 
have  been  invaded  by  the  poison  of  the  disease.  In  brachy- 
cardia the  heart  and  lungs  must  be  kept  stimulated  against  the 
occurrence  of  syncope  or  physical  prostration.  Treatment  in 
the  intervals  may  be  directed  to  upbuliding  the  general  health , 
mechanical  correction  of  the  body,  etc.  Proper  physical  train-' 
ing  to  strengthen  the  heart  muscle  is  valuable  in  all  cases,  and  is 
practically  all  that  is  necessary  in  some  cases. 

IRRITABLE  HEART  is  another  neurosis,  and  is  to  be  regarded 
in  the  same  light  as  the  above  conditions.  It  will  be  found  to 
depend  upon  practically  the  same  lesions,  and  readily  yields  to 
the  treatment.  Thorough  general  treatment  for  the  nervous 
system  should  be  added  to  that  given  the  heart.  The  digestive 
disturbances,  constipation,  etc.,  yield  readily  to  the  treatment 
for  those  conditions.  The  cardiac  uneasiness  is  overcome  by 
keeping  the  ribs  raised,  and  by  inhibition  of  the  heart's  action. 
The  patient  should  avoid  stimulants  and  overexertion. 

ANGINA  PECTORIS. 

DEFINITION:  Paroxysms  of  violent  pain  in  the  pecordial 
region,  extending  to  the  neck,  back  and  arms,  and  accompanied 
by  a  sense  of  impending  death.  It  is  said  to  be  largely  symp- 
tomatic. 

The  lesions  presented  in  the  above  cases  were  mainly  to 
the  left  ribs  over  the  heart.  One  case  showed  lesion  to  the  left 
clavicle,  affecting  the  subclavian  circulation.  Another  case  is 
reported  with  the  lesion  as  a  spreading  of  the  sixth  and  seventh 
left  ribs  anteriorly.  Lesions  to  the  ribs  over  the  heart  are  very' 
common  in  this  disease.  The  upper  dorsal  spine  is  often  affected. 


252  PRACTICE    OF    OSTEOPATHY. 

The  nature  of  the  pain  of  angina  pectoris  is  not  well  understood. 
Upper  dorsal  lesion  may  irritate  the  sensory  nerves  of  the  heart. 
(1st,  2nd,  and  3rd  dorsal.)  The  irritation  of  the  lesion  upon  the 
heart  may  result  in  a  neurosis  of  the  sensory  branches  of  the  vagi. 
Other  lesion  to  the  vagi  through  their  sympathetic  connections 
may  cause  it.  Some  writers  advance  the  theory  that  an  aortitis 
is  present  and  causes  it.  A  deranged  nerve-mechanism  as  the 
result  of  spinal,  rib  and  other  lesion,  seems  sufficient,from  an  osteo- 
pathic  point  of  view,  to  cause  this  disturbance.  The  fact  that 
it  is  usually  associated  with  some  form  of  organic  heart  lesion, 
arterio-sclerosis,  etc.,  is  not  contrary  to  the  idea  that  bony  le- 
sion is  at  bottom  the  cause  of  the  whole  bad  condition. 

The  prognosis  must  be  guarded  because  of  the  frequent 
presence  of  organic  heart  disease  in  cases  manifesting  angina 
pectoris.  The  prognosis  for  relief  is  good,  and  cases  are  often 
entirely  cured. 

The  treatment  consists  mainly  in  relieving  the  pain.  This 
may  be  best  accomplished  by  raising  the  left  lower  ribs  in  the 
region  of  the  heart,  especially  in  case  of  lesion  here,  by  adopting 
the  motion  described  for  inhibition  of  the  accelerators,  bringing 
pressure  over  the  upper  three  spinal  nerves  (cardiac  sensory)  at 
the  same  time,  and  also  relaxing  the  tissues  of  the  pecordial  region, 
with  additional  inhibition  of  the  pneumogastric  nerves. 

Spinal  inhibition  may  be  carried  down  along  the  spine  as 
low  as  the  6th  dorsal  nerve.  Inhibition  should  be  made  upon 
the  local  nerves  of  the  parts  to  which  the  pain  has  radiated,  as 
to  the  brachial  plexus,  the  cervical  and  spinal  nerves,  etc. 

A  general  course  of  treatment,  should  be  given  to  strengthen 
the  patient's  general  health,  to  correct  heart  action,  and  to  re- 
move all  lesions.  In  this  way  much  may  be  done  to  prevent  the 
recurrence  of  the  attacks.  The  patient  should  lead  a  quiet  life 
free  from  physical,  mental  and  emotional  extremes.  Rest  of  mind 
and  of  body,  and  a  good  diet,  are  helpful.  In  case  of  emergency 
use  of  the  ice-bag,  or  of  hot  applications  over  the  heart  may  be 
useful. 

ENDOCARDITIS  AND  MYOCARDITIS. 
These   are   inflammations   of   the   endocardium   and    of   the 


PRACTICE    OF    OSTEOPATHY.  253 

heart  muscle,  attended  by  various  pathological  and  degenera- 
tive changes  in  the  part  attacked.  The  extent  to  which  the  path- 
ological changes  go  in  most  of  these  cases  renders  a  cure  hope- 
less. All  forms  of  these  diseases  are  apt  to  produce  serious  val- 
vular lesions.  Aside  from  simple  acute  endocarditis,  death  is 
imminent  in  most  of  these  cases,  yet  much  may  be  done  in  in- 
dividual cases  to  alleviate  conditions  and  to  prolong  life. 

The  LESIONS  AND  ANATOMICAL  RELATIONS  as  pointed  out 
at  the  opening  of  the  chapter  apply  here.  It  is  seldom  that 
myocarditis  or  any  of  the  several  forms  of  endocarditis  seems 
to  occur  idiopathically.  How  far  the  actual  causes  of  these 
diseases  may  be  shown,  from  the  accumulation  of  osteopathic 
data,  to  be  specific  osteopathic  lesions  to  the  heart  remains  to 
the  future  to  decide.  The  accepted  cause  of  these  conditions 
generally  is  the  irritation  of  the  organ  by  the  poisonous  products 
of  disease.  Acute  articular  rheumatism  is  made  accountable 
for  40  per  cent  of  simple  acute  endocarditis.  Rheumatism,  ma- 
laria, scarlet  fever,  pulmonary  tuberculosis,  syphilis,  gout,  poison- 
ing, etc.,  are  looked  upon  as  the  primary  diseases  in  which  poison- 
ous products  are  generated  and  cause  endocarditis  or  myocardi- 
tis as  a  secondary  condition.  Various  other  causes  are  assigned. 

While  poison  in  the  system  is  admitted  by  the  Osteopath 
to  be  sufficient  cause  of  disease,  it  seems  likely  that  specific  le- 
sion to  the  cardiac  apparatus  has  much  to  do  in  weakening  the 
heart  and  laying  it  liable  to  the  invasion  of  these  diseases.  Cir- 
culation to  the  substance  of  the  heart  is  under  control  of  the 
coronary  plexus,  derived  from  the  cardiac  plexus.  Lesion  to  the 
latter  through  its  spinal  connections  may  affect  the  former  and 
disturb  the  nutrition  of  the  organ.  The  same  result  may  be 
produced  by  lesion  to  the  pneumogastrics,  said  to  contain  vaso- 
motor  fibres  to  the  heart  and  to  have  charge  of  trophic  condition. 
It  is  obvious  that  the  usual  cardiac  lesions  may  predispose  the 
heart  to  these  diseases.  The  direct  irritation  of  the  left  ribs  upon 
the  heart,  when  they  are  displaced,  may  directly  cause  pericarditis 
and  myocarditis.  As  medical  etiology  lays  most  of  these  cases 
to  the  action  of  bacteria,  it  is  reasonable  to  conclude  that  direct 
lesion  to  the  heart  deteriorates  the  vitality  of  its  tissues  and 
allows  them  to  gain  a  foothold. 


254  PRACTICE    OF    OSTEOPATHY. 

This  conclusion  is  strengthened  by  the  fact  that  endocarditis 
sometimes  follows  chronic  wasting  diseases,  such  as  diabetes  and 
gleet.  The  fact  that  chronic  endocarditis  may  be  due  to  mechan- 
ical influences,  may  be  caused  by  heavy  muscular  effort,  strain- 
ing, etc.,  and  the  further  fact  that  myocarditis  is  ascribed  by 
Anders  to  injuries  of  the  antero-lateral  thoracic  region  emphasizes 
the  idea  that  mechanical  lesions  regarded  as  important  by  the 
Osteopath  may  directly  cause  these  conditions. 

The  PROGNOSIS  for  simple  acute  endocarditis  is  good.  It  de- 
pends some  upon  the  primary  disease.  The  prognosis  for  chronic 
and  ulcerative  endocarditis  and  for  myocarditis  is  grave.  If 
specific  lesion  is  found  and  may  be  removed,  perhaps  much  may  be 
done  for  the  case — generally  speaking,  much  may  be  done  in  all 
of  these  cases  to  limit  the  disease  and  to  prolong  life.  Chronic 
endocarditis  has  been  cured. 

The  TREATMENT  is  practically  that  described  for  pericard- 
itis, q.  v.  Knowledge  of  the  nerve  and  blood-supply  and  of 
lesions  gives  one  the  key  to  the  situation.  The  lesion  and  all 
cause  of  irritation  must  be  removed,  and  the  patient,  in  the  acute 
stages,  is  kept  in  bed' to  keep  the  heart  quiet.  Inhibition  of  the 
accelerators  and  stimulation  of  the  vagi  is  done  as  directed. 
The  ribs  are  raised  to  give  the  best  freedom,  and  the  abdominal 
treatment  may  be  applied  to  draw  the  blood  away  from  the  heart 
and  aid  in  keeping  it  quiet. 

Strict  attention  must  be  given  the  primary  disease.  In 
those  generating  toxins  in  the  system  the  bowels,  kidneys  and 
liver  are  stimulated  to  excrete  the  poisons.  In  the  chronic  forms 
the  heart  and  its  connected  nerves  may  be  carefully  stimulated 
to  increase  its  tone  and  nutrition.  The  vegetation  in  acute 
endocarditis  may  be  absorbed. 

Prophylactic  treatment  in  rheumatism  and  in  those  dis- 
eases leading  to  these  conditions  consists  in  keeping  the  heart 
well  stimulated,  and  in  maintaining  free  action  of  kidneys  and 
bowels  to  excrete  the  poison. 

In  acute  endocarditis  the  precordial  pain  and  dyspnea,  if 
present,  are  relieved  by  carefully  elevating  the  ribs  in  the 
region  of  the  heart  by  elevating  the  arm  and  holding  it  up  behind 
the  head.  While  the  arm  is  held  in  this  position  the  intercostal 


PRACTICE  OF  OSTEOPATHY.  255 

tissues  about  this  region  should  be  manipulated  and  relaxed' 
The  upper  dorsal  spinal  region  should  be  inhibited,  from  the  1st  to 
the  6th  dorsal.  This  treatment  would  likewise  quiet  palpitation. 

The  heart  should  be  carefully  sustained  and  kept  gently 
stimulated,  especially  if  it  show  indications  of  failing. 

In  ulcerative  endocarditis  the  whole  progress  of  the  case 
must  be  carefully  watched.  If  it  accompany  a  septic  disease, 
especial  attention  must  be  given  that  condition,  and  the  chief 
indication  is  to  keep  the  poison  freely  excreted  from  the  sys- 
tem. Local  symptoms  of  this  form  of  endocarditis,  if  present, 
are  similar  to  those  for  which  the  treatment  has  been  described 
in  the  acute  form.  Gastro-intestinal  disturbance,  vomiting 
and  diarrhoea,  calls  for  such  treatment  as  has  been  described 
for  these  conditions.  The  local  circulation  to  eyes  and  kidneys 
should  be  kept  active  to  prevent  retinal  and  renal  hemorrhages, 
evident  as  hematuria  and  dimness  of  vision.  Kidneys  must 
be  stimulated  to  increase  the  urine,  which  may  become  scanty 
and  contain  albumen.  A  general  spinal  and  cervical  treatment 
is  necessary  to  quiet  the  general  nervous  system  and  to  relieve 
headache,  delerium,  somnolence  or  coma,  which  may  appear. 

Chronic  endocarditis  necessitates  such  treatment  as  is  de- 
scribed for  valvular  lesions,  q.  v. 

Myocarditis  should  be  treated  as  are  endocarditis  and  per- 
icarditis, conditions  which  it  frequently  accompanies  as  a  com- 
plication. It  is  necessary  to  keep  the  heart  quiet.  Enforce  ab- 
solute rest,  and  attend  to  the  general  nutrition. 

FATTY  DEGENERATION  OF  THE  HEART. 


DEFINITION:  A  condition  in  which  the  fitoes  of  the  cardiac 
muscle  are  converted  into  fat. 

LESIONS  such  as  have  been  pointed  out  affecting  the  heart 
may  be  present.  The  fact  that  this  condition  is  often  second- 
ary to  cardiac  hypertrophy,  q.  v.,  would  lead  one  to  work  for 
such  lesions  as  cause  it.  These  lesions  act  in  various  ways  to 
cause  the  heart  to  overwork  and  hypertrophy,  either  by  over- 
stimulation  of  the  accelerators,  obstruction  to  the  arterial  cir- 
culation, by  causing  valvular  lesion,  etc.  After  hypertrophy 


256  PRACTICE    OF   OSTEOPATHY. 

when  the  centers  and  parts  concerned  become  exhausted,  fatty 
degeneration  occurs. 

It  is  pointed  out  by  Anders  that  lesions  to  the  coronary  arteries 
are  the  most  significant  causes  of  fatty  degeneration.  Narrow- 
ing of  the  lumen  of  those  vessels  must  result  in  defective  nutri- 
tion of  the  cardiac  muscle,  and  fatty  degeneration  follows.  It 
was  pointed  out  above,  in  considering  the  general  anatomical 
relations  of  lesion  to  heart  disease,  that  these  coronary  arteries 
are  regulated  in  their  calibre  and  activities  by  the  coronary  plex- 
uses, right  and  left,  which  are  derived  from  the  cardiac  plexus. 
Hence  it  is  seen  that  lesions  to  the  vagus  and  to  the  sympathetic 
nerves  of  the  heart,  acting  through  the  cardiac  and  coronary 
plexus,  could  so  influence  these  vessels  as  to  narrow  their  lumen, 
and  cause  mal-nutrition  of  the  heart  leading  to  degeneration. 

Where  the  condition  is  due  to  a  cachetic  condition  of  the 
system,  as  in  phthysical  and  anemic  conditions,  and  when  it  is 
secondary  to  some  severe  acute  disease,  lesion  must  be  expected 
according  to  the  primary  disease. 

The  PROGNOSIS  must  be  guarded.  Sudden  death  may  en- 
sue. Yet,  on  the  other  hand,  much  may  be  done  to  strengthen 
the  heart  and  build  up  its  substance. 

The  TREATMENT  must  be  according  to  the  requirements  of 
the  individual  case.  In  each  case  the  special  cause  of  the  condi- 
dition  should  be  found  out  and  treated.  The  lesion  must  be  cor- 
rected. Special  attention  should  be  given  the  dilatation.  It  may 
be  treated  as  described  for  that  condition.  The  heart  should  be 
continuously  but  judiciously  stimulated,  because  of  the  weak- 
ness of  the  heart.  This  should  be  by  stimulation  to  the  accelera- 
tors in  the  uppe*  dorsal  region,  and  to  the  sympathetics  in  the 
neck.  This  increases  the  strength  of  the  beat  and  the  tone  of  the 
heart  muscle.  By  the  same  process,  and  by  removal  of  lesion, 
the  functions  of  the  coronary  plexuses  are  corrected,  free  circu- 
lation to  the  heart  muscle  is  brought  about,  and  it  is  better  nour- 
ished. 

The  palpitation,  dyspnea,  small  and  irregular  pulse,  and 
cool  extremities  are  due  to  the  cardiac  dilatation,  and  are  bene- 
fited by  treatment  of  that  condition.  Raising  the  ribs  and  stim- 
ulating the  heart  will  be  helpful  for  these  symptoms. 


PRACTICE   OP    OSTEOPATHY.  257 

Pseudo-apoplectic  attacks  may  occur,  and  should  be  promptly 
met.  The  patient  should  be  placed  upon  his  back  with  the  head 
a  little  raised.  The  heart  should  be  well  stimulated,  and  this 
treatment  should  be  extended  the  whole  length  of  the  spine. 
The  cervical  tissues  should  be  relaxed,  and  strong  inhibition  should 
be  made  in  the  sub-occipital  fossae  for  several  minutes.  Next 
the  splanchnics  should  be  inhibited  as  well  as  the  solar  plexus, 
and  the  treatment  should  be  given,  as  described  before,  to  call 
the  blood  to  the  abdominal  vessels.  By  this  procedure  systemic 
circulation  is  rendered  active,  the  blood  is  called  from  the  head, 
and  is  distributed  throughout  the  vascular  system. 

For  cardiac  asthma  treat  as  in  ordinary  asthma.  The  ribs 
should  be  occasionally  elevated,  and  the  lungs  should  be  kept 
well  stimulated,  to  overcome  breathlessness  and  the  Cheyne- 
Stokes  breathing  which  tends  to  appear.  Agina  pectoris  may  be 
treated  as  directed  for  that  condition. 

In  anemic  and  cachetic  conditions  responsible  for  the  fatty 
degeneration,  the  oxygen-carrying  power  of  the  blood  should  be 
increased  by  a  thorough  course  of  general  treatment  devoted  to 
the  upbuilding  of  the  general  health.  The  spleen,  bowels,  kid- 
neys, liver  and  gastro-intestinal  tract  should  receive  special 
stimulating  treatment. 

The  patient  should  be  kept  upon  a  carefully  regulated  diet. 
Light  exercise  invigorates  the  heart. 

FATTY  OVERGROWTH,  or  fatty  infiltration,  is  a  condition  in 
which  an  abnormal  amount  of  fat  is  deposited  in  the  auriculo- 
ventricular  groove,  beneath  the  visceral  layer  of  the  pericardium 
and  even  between  the  muscle  fibers  of  the  heart.  The  disease  is 
apt  to  occur  in  the  obese,  and  in  those  who  over-eat,  or  who 
lead  sedentary  lives. 

Such  LESIONS  as  before  mentioned  may  be  present,  inter- 
fering with  the  nerve  mechanism  of  the  heart  and  disposing  it 
to  this  condition,  or  causing  the  primary  disease  to  which  this  is 
secondary. 

The  PROGNOIS  is  good  for  cure. 

The  TREATMENT  consists  in  removal  of  lesion  and  in  due  at- 
tention to  the  primary  disease.  The  heart  should  be  kept  well 
stimulated  as  it  may  suffer  weakness  by  reason  of  atrophy  of  its 


258  PRACTICE    OF    OSTEOPATHY. 

fibers  and  the  liver.  It  tends  to  be  dilated,  and  may  then  be 
treated  as  described  for  dilatation  of  the  heart.  This  treatment 
overcomes  the  resultant  vertigo,  syncope,  dyspnea,  cyanosis, 
palpitation,  each  gf  which  may  be  especially  treated  as  before 
indicated,  as  may  also  the  asthma  and  bronchitis  which  are  apt 
to  occur.  In  obese  persons  it  is  well  to  keep  the  pancreas  and  the 
liver  stimulated.  (See  Obesity).  This  will  aid  in  preventing  the 
deposition  of  fat.  Also  one  should  administer  thorough  general 
treatment,  with  the  same  object  in  view.  Careful  and  contin- 
uous stimulation  of  the  heart  ni creases  the  tone  of  its  muscle  and 
the  strength  of  its  beat.  Exercise  helps  this. 

In  these  conditions  much  may  be  accomplished  by  diet  and 
exercise.  A  special  method  is  followed.  It  consists  in,  (1)  lim- 
iting the  supply  of  fluids  allowed  the  patient,  (2)  enforcing  a 
proteid  diet,  (3)  taking  as  much  exercise  of  a  special  kind  as  will 
l>e  tolerated  by  the  condition  of  the  heart.  The  fluids  are  limited 
to  36  oz.  in  twenty-four  hours.  The  diet  consists  of  coffee,  tea, 
or  water;  a  little  bread;  game,  veal,  or  beef;  salad,  vegetables, 
fruit  and  eggs.  The  exercise  is  walking  up  graduated  inclines,  to 
invigorate  the  heart  muscle.  This  is  well  accomplished  by  walk- 
ing up  hills,  varying,  from  mild  inclines,  gradually,  to  steeper  ones. 

VALVULAR  DISEASES. 

The  prognosis  in  cases  of  this  kind  is  not  generally  favor- 
able. As  a  rule,  valvular  disease  is  incurable.  Yet  some  cases 
may  be  cured,  and  a  fair  number  have  been  cured  by  osteopathic 
treatment.  In  cases  not  curable,  much  may  be  done  to  better 
the  patient's  condition,  and  prolong  his  life,  Cases  caused  by 
simple  dilatation  or  diminished  contractile  power  may  be  cured. 
Also  when  occurring  in  simple  acute  endocarditis  the  prognosis 
for  cure  is  good. 

LESIONS:  In  many  cases  of  valvular  lesion,  in  the  left  heart 
especially,  the  lesions  present  would  be  as  described  for  endo- 
carditis, to  which  disease  these  may  be  secondary.  In  tricuspid 
insufficiency  due  to  obstructed  pulmonary  circuit,  lesion  to  the 
lung,  as  ascribed  in  the  chapter  on  lung  diseases,  may  cause  the 
valvular  trouble. 

In  aortic  stenosis  from  increased  tension  in  the  aorta,  the 


PRACTICE    OF   OSTEOPATHY.  259. 

condition  may  be  due  to  lesion  to  the  diaphragm  as  explained, 
impeding  circulation  through  the  aorta.  The  same  result  may 
follow  extensive  arterial  obstruction,  as  of  all  the  intercostals. 
the  sub-clavians,  the  abdominals,  etc.,  as  explained  under  An- 
atomical Relations  at  the  opening  of  this  chapter.  Aortic  valvu- 
lar lesions  following  heavy  muscular  strains,  etc.,  may  be  due  to 
the  presence  of  some  one  of  the  various  lesions  described  as  affect- 
ing the  heart,  which  forms  a  predisposing  cause.  Lesions  to  the 
vagus  and  to  the  sympathetic  supply  of  the  heart  may  lead  to 
lack  of  tone  and  diminished  contractile  power  (see  general  anatomi- 
cal relations)  which  sometimes  causes  valvular  disease.  General 
lesions  to  the  cardiac  mechanism,  as  of  upper  vertebrae,  ribs, 
diaphragm,  vagi  and  sympathetics,  doubtless  weaken  the  heart 
and  act  as  predisposing  causes  to  the  valvular  lesion  which  so 
frequently  follows  other  disease. 

The  TREATMENT  in  ordinary  cases  would  be  to  sustain  the 
heart  and  to  maintain  compensation.  It  should  look  to  the 
removal  of  any  lesion,  or  of  any  obstruction  to  the  blood-current, 
especially  in  tricuspid  insufficiency  caused  by  obstructed  pul- 
monary circulation,  and  in  aortic  stenosis  due  to  increased  tension 
in  the  aorta.  Diaphragmatic  lesion  or  important  arterial  ob- 
struction may  be  present.  In  the  obstructed  pulmonary  circu- 
lation the  lungs  should  be  kept  stimulated  and  any  lesion  to  the 
lung  should  be  removed.  In  all  cases  the  whole  general  circula- 
tion must  be  kept  free  and  well  stimulated,  in  order  to  aid  the 
heart  to  carry  out  its  work,  thus  relieving  it  of  much  labor.  In 
cases  in  athletes,  or  due  to  heavy  muscular  strain,  one  should 
suspect  the  presence  of  definite  spinal  or  rib  lesion  due  to  such 
activities.  The  primary  disease  which  may  be  causing  the  trouble 
calls  for  treatment  according  to  its  kind.  In  diminished  con- 
tractile power  or  dilatation  of  the  left  ventricle  causing  mitral 
insufficiency,  the  accelerators,  should  be  stimulated,  as  this  in- 
creases cardiac  tonus  and  strength  of  beat,  and  contracts  the 
heart.  In  such  cases  lesion  should  be  suspected  to  the  vagus, 
as  lesion  to  this  nerve  may  diminish  ventricular  tonus,  dilate  the 
heart,  and  weaken  its  walls. 

In  all  such  cases  the  patient  should  lead  a  quiet  life,  free 
from  excitement  or  exertion.  He  should  be  much  out  of  doors, 


260  PRACTICE   OF    OSTEOPATHY. 

and  live  upon  a  light  nutritious  diet.  He  should  avoid  straining 
at  stool,  the  use  of  alcohol,  tobacco,  etc.  Bathing  is  recommended, 
with  exception  of  Turkish  baths. 

HYPERTROPHY  OF  THE  HEART. 

In  these  conditions  the  prognosis  is  fair.  Much  may  be 
done  to  maintain  the  patient  in  a  state  of  comfortable  health, 
preventing  dilatation.  Cases  may  sometimes  be  cured  by  os- 
teopathic  therapeutics.  The  prognosis  depends  upon  that  for 
the  condition  producing  the  hypertrophy.  In  such  forms  of 
valvular  diseases  as  are  curable  it  may  be  cured.  In  cases  due 
to  exopthalmic  goitre  it  may  be  curable. 

Such  LESIONS  as  before  described  in  cardiac  disease  may 
affect  the  nerve  connections,  etc.,  of  the  cardiac  mechanism, 
and  cause  or  predispose  to  the  condition.  A  common  cause  is 
obstruction  to  the  circulation  through  the  small  arteries.  In 
the  light  of  such  fact,  lesions  before  pointed  out,  causing  ob- 
structed pulmonary  circulation,  obstructed  aorta,  intercostals, 
subclavians,  abdominals,  etc.,  are  important.  As  the  heart 
hypertrophies  in  valvular  disease  frequently,  lesions  would  have 
to  be  sought  according  to  primary  conditions. 

Lesion  to  the  sympathetics,  as  in  exophthalmic  goitre, 
causing  hypertrophy  are  important.  Lesion  to  vagi  and  ac- 
celerators, resulting  in  over-activity  of  the  heart,  may  cause  hyper- 
trophy. When  such  simple  causes  as  the  use  of  alcohol,  coffee, 
tobacco,  etc.,  and  lead  poisoning,  etc.,  are  alleged,  one  is  bound  to 
suspect  one  of  the  ordinary  lesions  present  as  the  real  cause  allow- 
ing the  heart  to  be  affected  by  such  agents. 

The  TREATMENT  looks  to  the  lesion,  obstruction  to  the  blood- 
flow,  etc.  It  is  directed  to  the  primary  disease  when  the  hyper- 
trophy, as  is  the  rule,  is  a  secondary  condition.  The  circula- 
tion through  the  lungs  should  be  kept  free.  The  patient  should 
remain  quiet.  Attention  should  be  given  the  sympathetics  to 
slow  the  beat  as  much  as  possible. 

The  patient  should  lead  a  quiet  life,  free  from  excitement. 
His  diet  should  be  chosen  with  care,  and  he  should  particularly 
avoid  overeating,  alcohol,  coffee,  etc. 


PRACTICE    OF    OSTEOPATHY.  261 

DILATATION  OF  THE  HEART. 

DEFINITION:  There  may  be  simple  dilatation  of  a  cavity, 
causing  increase  in  its  size  and  thinning  of  its  walls.  The  dilata- 
tion may  be  accompanied  with  hypertrophy,  in  which  there  is 
increase  in  both  the  size  of  the  cavity  and  in  the  thickness  of  the 
muscular  wall. 

As  to  CAUSES,  the  lesions  as  discussed  would  be  sufficient. 
No  specific  lesion  has  been  pointed  out  for  this  condition.  Le- 
sions to  the  cardiac  mechanism  weaken  the  heart  and  thus  are 
especially  apt  to  predispose  to  dilatation.  Under  such  conditions 
over-exertion  and  great  physical  strain  would  be  more  likely 
to  cause  dilatation  of  the  right  ventricle.  As  the  vagus  nerve 
has  been  shown  to  have  a  trophic  influence  upon  the  heart  walls, 
also  an  influence  upon  their  dilatation,  lack  of  tone,  and  a  softened 
condition  of  them,  lesion  to  it  would  have  an  important  part  in 
the  production  of  dilatation.  Obstructed  circulation,  and  any 
cause  producing  increased  intra-cardiac  pressure  may  result  in 
dilatation.  This  is  seen  in  mitral  diseases.  Osteopathic  lesion 
causing  obstruction  to  the  intercostals,  abdominals,  pulmonary 
circulation,  etc.,  as  before  discussed,  may  become  the  direct  cause 
of  dilatation  of  the  heart. 

The  PROGNOSIS  is  not  good.  It  depends  upon  that  for  the 
primary  condition  often,  as  in  valvular  diseases  where  the  prog- 
nosis is  bad.  When  due  to  specific  removable  lesion  the  prog- 
nosis may  become  favorable. 

The  TREATMENT  consists  in  righting  of  mechanical  relations 
and  removal  of  lesion.  Ostruction  to  the  circulation  must  be 
relieved,  and  heart  and  lungs  must  be  kept  well  stimulated  to 
empty  the  chambers  of  the  heart  of  the  clotted  blood  that  is 
retained  in  them.  Stimulation  of  the  accelerators  aids  the  pro- 
cess by  steadying  and  strengthening  the  heart  beat,  contracting 
it  and  adding  tone. 

When  secondary  to  acute  infectious  disease,  valvular  dis- 
ease, etc.,  the  primary  condition  must  be  treated.  The  dropsy 
and  dyspepsia  present  depend  upon  the  bad  circulation  and  are 
treated  in  the  usual  ways.  Stimulation  of  the  lungs  and  raising 
the  ribs  relieve  the  dyspnea.  Stimulation  to  the  kidneys  in- 


262  PRACTICE    OF   OSTEOPATHY. 

creases  the  flow  of  urine,  which  has  been  lessened,  and  aids  in 
overcoming  the  dropsy. 

In  the  acute  form  the  patient  should  rest  in  bed.  In  the 
chronic  form  he  should  avoid  fatigue.  General  directions  for 
the  care  of  the  patient  are  as  before  given. 

CARDIAC  DROPSY  should  be  treated  upon  the  same  plan  as 
renal  dropsy,  q.  v.  The  kidneys  should  be  kept  thoroughly  stim- 
ulated to  quicken  their  excretory  action  and  to  thus  relieve  vascu- 
lar tension.  The  heart  and  general  circulation  should  be  kept 
gently  stimulated  in  order  to  lessen  venous  stasis,  to  help  out 
cardiac  compensation,  and  to  force  the  lymph  into  the  circulation. 

ARTERIO-SCLEROSIS  calls  chiefly  for  a  general  palliative 
course  of  treatment,  equalizing  and  aiding  general  circulation, 
and  attending  to  the  special  disease  or  cause  that  is  responsible 
for  the  condition.  As  the  lack  of  elasticity  in  the  blood  vessels 
interferes  with  the  propulsion  of  blood  through  them,  the  heart 
should  be  kept  well  stimulated,  and  general  circulation  should 
be  aided  by  a  general  spinal  and  muscu-lar  treatment.  To  this 
may  be  added  the  abdominal  treatment,  and  the  treatment  which 
regularly  elevates  and  depresses  the  ribs,  thus  aspirating  the  ven- 
ous blood  and  toning  general  circulation.  This  treatment  also 
meets  the  important  indication  of  increasing  the  blood-supply 
to  the  viscera,  as  it  has  been  lessened.  Keeping  the  heart  well 
stimulated  maintains  the  balance  of  the  cardio-vascular  forces, 
and  this,  with  the  aid  given  the  general  circulation  by  the  above 
treatment,  renders  less  necessary  the  hypertrophy  of  the  left 
ventricle,  that  is,  limits  the  progress  of  such  hypertrophy. 

By  this  plan  of  procedure,  myocardial  degenerations  and 
dilatation  of  the  left  ventricle,  common  in  the  latter  stages,  as 
well  as  the  dilatation  of  the  aorta  often  present,  are  rendered  less 
probable. 

Palpitation,  dyspnea,  angina,  and  precordial  constriction 
are  treated  as  before  directed. 

The  cerebral  type  calls  for  cervical  treatment  to  lemove 
any  obstruction  to  the  circulation,  and  to  aid  the  blood-flow  to 
the  brain.  Raising  the  clavicles,  opening  the  mouth  against 
resistance,  working  along  the  course  of  the  carotids,  etc.,  may  all 
be  useful.  The  special  effects  in  this  type,  such  as  tinnitus, 


PRACTICE    OF    OSTEOPATHY.  263 

syncope,  headache,  vertigo  and  the  like,  are  remedied  by  cor- 
rected circulation.  They  may  be  treated  in  the  usual  ways. 

Likewise  lungs  and  kidneys  should  be  vigorously  treated  to 
prevent  their  involvement,  and  the  circulation  to  the  extremities 
should  be  kept  active  to  prevent  starvation  of  the  tissues  and 
resulting  gangrene. 

Much  may  be  done  to  retard  the  progress  of  the  disease  by 
correcting  any  habit  that  favors  the  disease,  such  as  the  use  of 
alcohol,  excessive  eating  and  drinking,  muscular  over-strain,  etc. 
The  diet  should  be  light  and  non-stimulating. 

Rheumatism,  gout,  syphilis,  Bright 's  disease,  mitral  dis- 
ease, emphysema,  and  other  diseases  which  predispose  to  arterio- 
sclerosis, should  be  carefully  looked  after. 

ANEURYSMS. 

The  treatment  of  arieurysms  must  be  largely  palliative. 
Under  favorable  conditions  the  danger  to  life  from  the  aneu- 
rysm  may  be  greatly  lessened,  and  the  contents  of  the  sac  may  be 
clotted,  practically  curing  the  case. 

The  treatment  must  be  with  great  care.  Any  considerable 
handling  of  the  patient,  in  the  way  of  strong  treatments,  must 
be  avoided  on  account  of  the  danger  of  rupture  of  the  aneurysm. 

It  is  probable  that  various  lesions,  affecting  vaso-motor 
and  trophic  nerves,  weaken  the  vessels,  and  lay  them  liable  to 
aneurysm  by  action  of  various  causes,  such  as  sudden  great  strain 
from  physical  exertion,  arterio-sclerosis,  etc.  It  is  likely  that 
spinal  and  rib  lesions,  acting  upon  the  innervation  of  the  thoracic 
aorta,  and  often  combined  with  lesion  to  the  diaphrgam  which 
allows  it  to  obstruct  the  aorta,  may  be  the  causesof  weakness  and 
strain  upon  this  vessel  that  result  in  aneurysm. 

With  the  Osteopath,  as  with  other  physicians,  the  object 
of  treatment  must  be  to  decrease  arterial  tension,  produce  clotting 
of  the  blood  in  the  sac,  and  favor  contraction  of  the  walls  of  the 
sac. 

It  is  necessary  for  the  patient  to  remain  entirely  quiet  upon 
his  back,  thus  diminishing  the  number  of  heart  beats,  as  well  as 
their  strength,  and  at  the  same  time  the  pressure  of  the  blood  in 
the  sac.  A  most  valuable  aid  in  this  process  is  a  large  amount  of 


264  PRACTICE  OF  OSTEOPATHY. 

inhibiting  treatment  applied  to  the  accelerator  innervation  of  the 
heart.  (2nd  to  5th  dorsal  and  lower  cervical).  As  the  patient 
lies  upon  his  back,  the  operating  hand  may  be  slipped  beneath 
the  shoulder  and  inhibition  be  applied.  The  free  hand  may  press 
the  shoulder  down  upon  the  inhibiting  fingers.  If  the  left  arm 
be  raised  above  the  head  to  aid  in  this  treatment,  it  should  be 
done  slowly  and  cautiously.  This  treatment  diminishes  force 
and  frequency  of  the  heart  beat. 

It  is  also  of  the  greatest  importance  to  decrease  arterial 
tension  by  further  inhibitive  treatment  applied  to  the  superior 
cervical  region  to  affect  the  general  vaso-motor  center  in  the 
medulla.  To  this  should  be  added  the  treatment  for  dilating 
the  abdominal  vessels  and  calling  the  blood  to  them.by  inhibition 
of  the  splanchnic  area  of  the  spine  and  by  the  inhibitive,  relaxing 
treatment  to  solar  plexus  and  abdomen,  as  before  described. 
This  treatment  locally  upon  the  abdomen  cannot  be  applied  in 
.case  of  abdominal  aneurysm,  but  the  remainder  of  the  treatment 
may  be  safely  used. 

Any  lesion  or  source  of  obstruction  to  the  vessels,  partic- 
ularly to  the  aorta*,  should  be  removed.  The  diaphragm,  if 
prolapsed,  should  be  raised,  and  it  should  be  sustained  by  a  belt 
about  the  lower  costal  region.  The  palpitation  of  the  heart  may 
be  quieted  by  the  inhibition  applied  to  the  accelerators;  the  dysp- 
nea by  very  cautious  and  gentle  elevation  of  the  ribs;  the  pain  by 
inhibition  of  the  local  nerve-supply  of  the  part  affected;  other 
symptoms,  according  to  their  kind,  may  be  met  by  the  usual 
osteopathic  procedures.  While  most  of  these  symptoms  are  due 
to  pressure  from  the  aneurysm,  the  treatment  is  employed  to 
relieve  and  to  make  the  patient  comfortable. 

The  methods  employed  to  reduce  blood-pressure,  etc.,  also 
favor  contraction  of  the  sac. 

Tufnell's  treatment  by  absolute  rest  in  the  recumbent  po- 
sition, and  a  restricted,  dry  diet  is  highly  recommended.  The 
dietary  consists  of  2  oz.  of  bread  and  butter  and  2  oz.  of  milk 
for  breakfast;  2  or  3  oz.  of  meat  and  3  or  4  oz.  of  milk  or  claret 
for  dinner;  2  oz.  of  bread  and  2  oz.  of  milk  for  supper.  This 
regimen  must  be  persisted  in  for  several  months,  in  order  to  bring 
about  sufficient  diminution  of  the  blood-volume. 


PRACTICE,  OF    OSTEOPATHY.  265 

/    ' 

Surgical  methods  are  often  necessary  for  the  reduction  of 
aneurysm. 

The  patient  should  avoid  stimulating  diet  and  drink,  and 
should  avoid  excitement. 

VARICOSE  VEINS,  (ANEURYSM  OF  VEINS). 

DEFINITION:  This  is  a  condition  in  which  the  veins  be- 
come enlarged,  elongated,  tortuous,  and  distended  with  blood 
It  may  occur  in  various  parts  of  the  body,  and  is,  generally  speak- 
ing, due  to  obstruction  to  the  blood-flow  from  the  veins,  by  le- 
sions of  various  kinds.  The  term  "varicose  veins"  is  applied 
especially  to  this  condition  in  the  lower  extremities,  in  which  the 
internal  saphenous  suffers  most  often. 

The  LESIONS  are  bony,  muscular,  tendinous,  etc.,  or  pressure 
from  adjacent  organs  or  growths,  obstructing  the  venous  flow. 
The  course  of  the  vessel,  its  surrounding  anatomical  parts,  and 
sources  of  its  innervation,  must  be  carefully  examined  for  sources 
of  obstruction,  the  simple  removal  of  which  constitutes  the  effic- 
ient treatment  in  these  cases. 

In  the  case  of  the  internal  saphenous  vein  there  are  numer- 
ous lesions  which  may  act  to  obstruct  the  flow  of  blood.  One 
of  the  most  common  of  these  is  tension  or  thickening  of  the  tis- 
sues about  the  saphenous  opening,  impeding  the  out-flow  from 
the  vein.  Sometimes  relaxed  abdominal  walls,  or  ptosis  of  the 
abdominal  viscera,  may  cause  pressure  upon  the  femoral  vein 
where  is  passes  beneath  Poupart's  ligament.  A  displaced  or 
pregnant  uterus,  or  a  loaded  caecum  or  sigmoid,  may  bring  pres- 
sure upon  the  iliac  veins,  and  cause  varicoses  in  the  ex- 
tremities. It  is  also  possible  for  a  prolapsed  diaphragm,  com- 
pressing the  azygos  veins  and  obstructing  the  ascending  vena 
cava  to  produce  a  like  result. 

The  vaso-motor  innervation  to  the  lower  limbs  is  from  the 
lower  dorsal,  lumbar,  and  sacral  sympathetic  ganglia,  and  lesion 
to  lower  dorsal  vertebrae,  lower  ribs,  lumbar  vertebrae,  innomi- 
nate bones,  sacrum,  or  pelvis  may  act  through  the  connected 
nerves  to  weaken  the  vaso-motor  state  of  the  arteries  of  the 
lower  limbs,  cause  weakness  of  the  circulation,  and  allow  such 
causes  as  excessive  standing  to  cause  varicoses.  Dislocations  of 


266  PRACTICE    OF    OSTEOPATHY. 

the  hip,  partial  or  total,  tense  the  tissues  and  muscles,  obstruct- 
ing venous  return,  and  causing  this  condition. 

When  the  condition  is  due  to  pressure  from  tumors  in  the 
abdomen  or  pelvis,  heart  or  lung  disease,  ascites,  etc.,  the  lesion 
must  be  sought  according  to  such  primary  condition. 

The  PROGNOSIS  is  good.  Very  severe  and  long  standing 
cases  can  be  cured.  Osteopathic  treatment  has  cured  very  many 
cases  in  which  the  enlarged  veins  had  reached  a  large  size.  Ulcers 
and  eczema  resulting  from  varicose  veins  heal  up  after  the  cir- 
culation is  restored. 

The  TREATMENT  is  directed  at  once  to  the  removal  of  the 
obstruction.  In  case  of  obstruction  at  the  saphenous  opening 
one  may  employ  such  a  treatment  as  described  in  Chap.  X. 
The  intestines  should  be  raised  from  the  femoral  vein  (III,  IV, 
Chap.  VIII);  the  prolapsed  uterus  should  be  replaced  (  Chap. 
IX,  E) ;  the  abdominal  walls  should  be  strengthened  by  local 
treatment  and  by  treatment  to  the  spine;  and  in  like  manner 
tumors,  a  constipate^  bowel,  ascites,  diseases  of  heart  or  lungs, 
etc.,  should  be  treated  as  necessary  according  to  directions  given 
for  those  various  conditions.  Tight  garters  should  not  be  worn. 
Lesion  to  lower  ribs,  spine,  pelvis,  etc.,  should  be  corrected. 
Special  treatment  is  given  in  these  cases  to  stimulate  the  vaso- 
motor  innervation  of  the  limbs  to  aid  in  keeping  the  circulation 
active.  Likewise,  a  muscular  treatment  of  the  limbs,  with 
flexion,  circumduction,  etc.,  and  thorough  abdominal  treatment, 
reaching  the  iliac  veins,  the  ascending  cava.  the  portal  circula- 
tion, etc.,  would  be  found  helpful.  The  liver  should  be  kept 
free,  and  the  bowels  as  well. 

Care  must  be  taken  in  the  treatment  that  the  thinned  walls 
of  the  veins  do  not  rupture  and  cause  serious  hemorrhage.  In 
case  of  varicose  ulcers,  and  of  eczema,  the  part  should  be  kept 
clean,  and  a  healing  dressing  may  be  applied,  but  the  parts  must 
not  be  kept  irritated  by  too  frequent  washing.  Ulcers  and 
eczema  heal  when  the  circulation  is  made  free. 

Thrombi  may  form  in  the  varicosed  veins,  and  care  must 
be  taken  to  absorb  them,  not  to  break  them  down,  on  account  of 
the  danger  of  embolism. 

Bandages,  silk  stockings,  etc..  are  gradually  removed,  and 


PRACTICE    OF    OSTEOPATHY,  267 

the  vessels  and  circulation  are  strengthened  to  take  care  of  them- 
selves.    Elevation  of  the  limb  and  recumbency  help. 


DISEASES  OF  THE  NERVOUS  SYSTEM. 

CHOREA.     (St.  Vitus  Dance). 

DEFINITION:  A  disease  of  the  nervous  system  character- 
ized by  involuntary  contraction  of  muscle  groups,  accompanied 
by  weakness,  and  often  by  slight  mental  derangement,  due  to 
spinal  lesions  interfering  with  motor  function  of  brain  or  cord. 

CASES:  (1)  A  case  in  a  young  girl,  of  three  or  four  months 
standing;  very  severe;  had  lost  all  control  of  hands  and  feetr 
and  of  speech;  could  take  only  liquid  food.  It  was  thought  she 
could  not  live.  Lesions  were  found  at  the  atlas  and  4th  dorsal 
vertebrae.  The  case  was  cured. 

(2)  In   a   boy   of   nine,    chorea   followed   vaccination.     Le- 
sion was  found  at  the  atlas  and  at  the  2nd  to  4th  dorsal  verte- 
brae.    Case  cured  in  five  weeks. 

(3)  A  case  in  a  child  of  eleven,  of  nine  months  standing. 
Very  severe;  no  sleep  for  six  nights;  power  of  articulation  was 
lost.     Six  weeks  of  treatment  showed  great  improvement. 

(4)  A  girl  of  ten;  marked  lesion  of  the  atlas,  and  of  the  3rd 
and  4th  cervical  vertebra?;  the  2nd  to  6th  dorsal  vertebrae  were 
irregular  and  lateral;  5th  lumbar  posterior;  cured  in  four  rnonths. 

(5)  Case  of  two  years  standing  in  a  boy  of  twelve;  right 
hand  useless  and  carried  in  a  sling;  lesion  at  1st  and  3rd  dorsal. 
Under  treatment  he  became  able  to  write  well  in  one  month. 
The  case  was  cured. 

(6)  A  case  of  two  years  standing  in  a  girl  of  thirteen.     She 
had  grown  continually  worse  under  usual  treatment.     The  atlas 
was  found  displaced  to  the  left,  and  upon  its  being  replaced  at  the 
second  treatment  the  jerking  of  the  muscles  began  to  grow  less 
at  once.     The  case  was  cured  and  the  child,  previously  under- 
sized, grew  rapidly  thereafter. 

(7)  The  patient  was  a  girl  of  thirteen;  confined  to  the  bed; 
arms  and  limbs  drawn  and  useless;  she  could  not  sleep,  or  speak 
intelligently.     Bony  lesions  were  found  in  the  cerivcal  and  lower 


268  PRACTICE    OF   OSTEOPATHY. 

dorsal  regions,   and  all  the  spinal  muscles  were   contractured. 
The  case,  of  three  months  standing,  was  cured  in  one  month. 

(8)  A  case  of  acute  chorea,  in  a  girl  of  7,  a  pupil  in  the  pub- 
lic  school.     Lesions  were:  2nd   dorsal   lateral,   6th   dorsal   pos- 
terior, slight  curvature  to  the  left  in  the  dorsal  region,  muscles 
in  cervical  region  contractured.     Inhibition  at  the  sub-occipital 
region   controlled  the  twitching  of  the  muscles  at  once.     The 
case  was  cured. 

(9)  A  case  in  a  girl  of  10,  which  had  been  gradually  coming 
on  for  six  months.     Atlas  and  axis  were  luxated  to  the  right; 
1st  and  8th  dorsal  vertebra  deviaed  laterally;  5th  and  6th  ribs 
drawn  together.     Overstudy  at  school  was  the  direct  exciting 
cause.     She  was  cured  in  2^  months. 

(10)  Huntingdon's   Chorea.     A    case    of   hereditary    chorea 
is  reported,  which  was  without  a  doubt  a  true  case  of  Hunting- 
don's chorea.     The  father  and  mother  had  both  been  sufferers 
from  chorea;  the  very  marked  affection  of  many  muscle  groups 
was  present;  the  child  was  very  dull,  and  had  been  regarded  as 
having   lost   her   mind.     The   condition   was  confirmed,  chronic, 
and  hereditary.     The  I2nd  and  3rd  dorsal  vertebrae  were  anterior. 
The  case  was  cured. 

LESIONS  AND  ANATOMICAL  RELATIONS:  The  lesions  in  these 
cases  are  found  in  the  majority  in  the  upper  dorsal  and  cervical 
regions.  Eight  of  the  above  cases  described  lesion  and  are 
illustrative  of  the  facts  generally  observed  in  such  cases.  All 
showed  lesion  in  the  cervical  or  upper  dorsal  region,  one  or  both. 
Neck  lesion  is  important  in  these  cases. 

Six  of  the  above  showed  cervical  lesion,  five  of  the  six  being 
atlas  lesions.  The  fact  that  atlas  lesions  alone  may  cause  the 
disease  is  illustrated  by  case  (6) .  The  fact  that  the  upper  dorsal 
lesion  alone  may  cause  it  is  illustrated  by  case  (5).  But  fre- 
quently, as  in  four  of  those  reported,  combined  lesion  of  the 
cervical  and  upper  dorsal  regions  occur.  The  upper  dorsal 
lesion  is  perhaps  the  most  important  one.  Six  of  the  above 
showed  lesion  somewhere  in  the  upper  six  dorsal  vertebras.  The 
spinal  area  from  the  atlas  to  the  6th  dorsal  may  be  regarded  as 
the  important  locality  for  lesions  producing  chorea.  They  may 
occur  lower  or  affect  the  ribs  as  well  as  vertebrae. 


PRACTICE    OF    OSTEOPATHY.  269 

These  lesions  high"  up  in  the  spine  may  involve  the  cord 
and  brain,  in  a  similar  manner  but  lesser  degree,  as  in  paralytic 
affections  of  the  whole  body.  The  frequent  occurrence  of  high 
lesion  explains  the  usual  general  effect  of  the  disease  upon  the 
whole  body,  including  the  upper  and  lower  limbs,  and  suggests 
the  idea  that  the  cord,  brain,  or  both  are  involved  by  the  lesion, 

The  authors  state  the  pathology  of  this  condition  is  obscure 
no  constant  lesions  being  found.  Probably,  as  McConnell  ob- 
serves, this  is  due  to  the  fact  that  spinal  lesion  may  often  involve 
simply  nerve-fibers.  Some  writers  hold  the  disease  to  be  a  func- 
tional brain  disturbance  affecting  the  centers  controlling  the 
motor  apparatus.  From  this  point  of  view  cervical  and  atlas 
lesion  have  important  bearing,  as  they  may  influence  brain  cen- 
ters by  interference  with  blood-supply  to  the  brain  through  direct 
impingement  upon  the  vertebral  arteries  and  by  disturbance  of 
the  cervical  sympathetics.  Upper  dorsal  lesions  aid  this  effect 
by  sympathetic  disturbance.  From  this  viewpoint  either  atlas, 
other  cervical,  or  upper  dorsal  lesion  alone  could  cause  the  dis- 
ease. 

It  is  worthy  of  note  that  the  upper  dorsal  lesion  (1st  to  6th) 
falls  upon  a  portion  of  the  cord  richer,  perhaps,  than  any  other 
in  sympathetic  centers.  The  cilio-spinal  center,  vaso-motors 
to  face  and  mouth,  pupillo-dilator  fibers,  motor  fibers  to  involun- 
tary muscles  of  the  orbit,  vaso-motors  to  the  lungs,  accelerators 
to  the  heart,  etc.,  all  occur  within  this  spinal  area.  This  dis- 
turbance to  the  sympathetic  may  have  much  to  do  in  unbalanc- 
ing the  nervous  system  in  such  cases.  This  lesion  could  a]so 
effect  spinal  fibers  by  impingement,  or  the  nutrition  of  the  cord 
through  sympathetic  disturbance  of  its  blood-supply. 

On  the  whole  the  likely  pathology  in  this  disease  is  that 
there  is  cord  lesion  or  brain  lesion  due  to  mechanical  irritation  or 
to  cut  off  nutrition.  These  various  lesions  weaken  the  portions 
of  the  nerve-system  involved,  and  lay  it  liable  to  the  action  of 
such  reflex  causes  as  irritation  due  to  parasites,  eye-strain,  nasal 
disease,  sexual  disorders,  etc.,  or  to  such  causes  as  over-study, 
shock,  worry,  strain,  etc. 

The  PROGNOSIS  is  good.  It  is  rare  that  the  treatment  fails 
to  cure  or  greatly  relieve  the  case.  Cure  in  a  short  time  is  the 


270  PRACTICE    OF    OSTEOPATHY. 

rule,  even  in  serious  and  long  standing  cases. 

The  TREATMENT  consists  mainly  in  removal  of  lesion  as  the 
real  cause.  In  some  cases  this  is  the  sole  treatment  necessary. 
Ordinarily  it  is  necessary  to  carry  the  patient  through  a  course 
of  treatment.  All  causes  of  irritation  or  nerve-strain  should 
be  removed.  Such  are  intestinal  worms,  causes  of  worry,  etc., 
as  noted  above.  An  important  measure  in  these  cases  is  the 
treatment  upon  the  neck  and  spine  for  the  general  nervous  sys- 
tem. The  neck  treatment  reaches  the  sympathetic  system,  the 
medulla,  the  circulation  to  the  brain,  and  influences  the  whole 
nervous  system.  It  consists  of  the  removal  of  lesion,  relaxation 
of  tissues,  inhibition  or  stimulation  of  the  cervical  nerves  and 
centers,  etc.  The  spinal  treatment  is  upon  the  same  plan.  It 
should  be  carried  down  along  the  spine.  These  treatments 
quickly  relieve  nervous  tension  and  quiet  the  nervous  system. 
They  correct  the  circulation  to  the  brain  and  central  nervous 
system,  increasing  their  nutrition,  and  stopping  the  muscular 
twitching  characteristic  of  these  conditions.  Inhibition  of  the 
superior  cervical  ganglion  may  also  aid  in  stopping  the  twitch- 
ing. An  important  treatment  is  the  removal  of  contracture  of 
the  muscles  all  along  the  spine,  common  in  these  cases.  At- 
tention must  be  given  to  the  patient's  general  health.  The 
heart  is  often  very  fast  and  should  be  slowed  in  the  way  already 
described.  The  kidneys  should  be  stimulated  and  general  meta- 
bolism in  the  body  looked  to,  to  increase  too  light  specific  gravity 
of  the  urine.  The  bowels  must  be  kept  regular. 

A  thorough  general  treatment  should  be  given  to  the  mus- 
cular system,  especially  to  those  muscle  groups  involved  in  the 
disease.  This  includes  flexion  and  circumduction  of  limbs  and 
arms,  etc. 

In  some  cases  inhibition  of  the  cervical  sympathetic  will 
cause  the  muscular  twitching  to  cease  at  once.  It  has  been 
accomplished  by  pressure  between  the  3rd  and  4th  cervical  ver- 
tebrae. 

In  the  hygienic  treatment  of  the  case  all  causes  of  nerve- 
strain,  over-work  mentally,  excessive  physical  exertion,  etc., 
must  be  removed.  Muscular  exertion  may  lead  to  heart  involve- 
ment, especially  as  cervical  and  upper  dorsal  lesion  favor  such 


PRACTICE    OF   OSTEOPATHY.  271 

conditions.  The  diet  should  be  light  and  nutritious.  Fruits 
and  vegetables  may  be  taken,  but  meats  and  highly  seasoned 
foods  should  be  avoided.  Sponging  of  the  back,  chest  and  neck 
with  cold  water  is  useful. 

The  various  CHOREIFORM  AFFECTIONS,  such  as  the  spasmodic 
tics,  habit  chorea,  laryngeal  tic,  choreic  wry-neck,  facial  tic, 
jumping  disease,  etc.,  also  rhythmic  or  hysteric  chorea,  fibrillary 
chorea,  athetosis,  and  various  other  forms,  are  met  in  the  same 
way.  A  number  of  such  cases  have  been  cured. 

Huntingdon's  chorea,  a  hereditary  disease  with  progressive 
dementia,  is  a  very  grave  disease. 

EPILEPSY. 

DEFINITION:  A  disease  in  which  there  is  loss  of  conscious- 
ness, with  or  without  convulsions.  From  the  osteopathic  point 
of  view  it  is  caused  by  lesions  interfering  with  the  nutrition  of 
cord  or  brain,  or  irritating  the  motor  nerve  strands  running  to 
the  peripheral  motor  structures,  or  exciting  connected  nerves. 

CASES:  (1)  A  case  showing  lesions  at  7th  and  llth  dorsal 
vertebrae.  Under  the  treatment  the  attacks  were  much  decreased 
in  frequency  not  having  appeared  for  a  considerable  period. 

(2)  A  case  of  more  than  one  year's  standing  in  a  girl  of 
thirteen;  three  to  twelve  attacks  daily;  lesions  in  upper  cervical 
spine,   posterior   curvature   from   6th   dorsal   to   lower  lumbar, 
marked  lesions  occurring  at  the  6th  dorsal  and  at  the  5th  lumbar; 
all  spinal  muscles  very  rigid.     Improvement  began  at  once  upon 
treatment,  and  the  case  was  cured  in  three  months. 

(3)  A  case  of  fifteen  years  standing  in  a  man  of  thirty.     No 
attacks  occurred  after  the  first  treatment,  and  the  case  was  cured 
in   four   months.     No   recurrence    of   attacks   nineteen    months 
later. 

(4)  Daily  attacks  in  a  boy  of  eighteen,  apparently  due  to  a 
nervous  stomach  disease.     The  latter  was  cured  in  three  months, 
and  no  further  attack  had  occurred  six  months  afterward. 

(5)  A  case  of  fourteen  years  duration  in  a  lady  of  eighty 
was  cured  in  two  treatments.     No  attack  occurred  after  the  first 
treatment.     The  report  was  made  two  and  a  half  years  after  the 
cure,  no  further  attack  having  occurred. 


272  PRACTICE    OF    OSTEOPATHY. 

(6)  In  a  boy  of  twelve,  monthly  spells  of  two  days  dura- 
tion occurred,  during  which  he  would  have  from  three  to  five 
spasms.     The  3rd  cervical  vertebra  was  found  turned  far  to  the 
right.     Under  a  three  months  course  of  treatment  he  had  not  had 
the  last  two  monthly  spells. 

(7)  A  case  of  petit  mal  in  a  young  man  of  thirty.     Lesions 
at  the  atlas,  which  was  to  the  right  and  turned  with  the  right 
transverse  process  backward,  and  at  the  axis,  displaced  to  the 
left.     Case  still  under  treatment. 

(8)  A  case  of  petit  mal  due  to  lesion  of  the  atlas  to  the  right 
and  back,  and  of  the  2nd  cervical  to  the  left. 

(9)  A  case  in  a  woman  of  31.     The  atlas  was  slipped  to  the 
left;  4th  cervical  much  to  the  left,  and  3rd  to  the  right;  1st,  2nd, 
6th,  7th  and  8th  dorsal  posterior;  marked  separation     between 
5th  lumbar  and  sacrum;  left  ribs  considerably  down.     A  his- 
tory of  severe  falls  during  childhood  was  noted.     The  disease  was 
over  23  years  standing.     The  lesion  at  the  3rd  cervical  seemed  the 
greatest  source  of  irritation.     When  its  condition  was  exaggerated 
it  caused  an  attack.     Immediate  benefit  was  given  by  the  treat- 
ment, but  the  case  did  not  remain  under  treatment  until. cured. 
When  first  seen  the  patient  was  in  a  series  of  attacks  lasting  two 
to  three  days.     The  attacks  began  at  once  to  be  less  frequent  and 
were  two  months  or  more  apart  when  treatment  ceased. 

(10)  A  case  of  six  years  standing  in  a  woman  of  22,  the  at- 
tacks coming  on  first  after  a  fall  down  stairs,  in  which  the  side 
was  hurt.     Lesion  was  found  as  downward  luxation  of  the  left 
12th  rib,  and  prolapsus  or  contraction  of  the  diaphragm.     The 
treatment  was  to  the  removal  of  lesion  and  to  equalize  circula- 
tion.    Benefit  came  by  the  first  treatment,  and  the  case  was  cured 
in  three  months. 

(11)  A  case  of  nine  years  standing  in  a  woman  of  32.     The 
attacks  were  at  first  nocturnal,  later  coming  on  in  the  daytime. 
Lesion  was  a  right  lateral  condition  of  the  atlas,  with  marked 
contracture  of  the  deep  and  superficial  muscles  along  the  spine. 
The  condition  was  at  once  benefited,  and  a  cure  was  gotten  in 
three  months  of  treatment.     The  lesion  of  atlas  was  bettered  at 
the  first  treatment,  giving  relief.     During  an  attack  the  patient 


PRACTICE    OF    OSTEOPATHY.  273 

was  brought  out  of  it  in  five  minutes  by  strong  pressure  over  the 
solar  plexus. 

(12)  A  case  of  epileptiform  seizures  in  a  woman  of  20,  of 
three  years  standing.     The  atlas  was  to  the  right;  the  spine  was 
posterior  from  the  12th  dorsal  to  sacrum;  the  spinal  muscles  and 
the    tissues    were    contractured.     The    uterus    was    anteflexed. 
Under  treatment   the   case   was   much   benefited.     The   attacks 
were  rendered  much  lighter  and  much  less  frequent. 

(13)  In  a  case  of  epilepsy  in  a  boy,  removal  of  lesion  to  the 
coccyx  cured  a  case  after  all  other  means  had    failed. 

LESIONS  AND  ANATOMICAL  RELATIONS:  It  seems  that  le- 
sion along  the  neck  and  spine  anywhere  may  cause  epilepsy. 
Dr.  A.  T.  Still  is  credited  with  the  statement  that  there  is  usually 
lesion  between  the  2nd  and  3rd  cervical  vertebrae.  He  also 
ascribes  epilepsy  to  lesion  causing  prolapse  of  the  diaphragm,  and 
obstruction  to  the  arterial  and  venous  blood,  and  of  the  lymph, 
in  the  vessels  perforating  it.  In  this  way  the  products  of  digest- 
ion are  retained  and  decompose,  the  patient  suffering  from  auto- 
intoxication. 

Lesions  in  the  above  cases  occurred  at  the  atlas,  cervical 
region,  and  from  the  middle  dorsal  down  to  the  last  lumbar. 
McConnell  states  that  lesions  occur  often  in  the  splanchnic  area 
and  to  the  ribs,  especially  in  the  spinal  region  between  the  4th 
and  8th  dorsal  vertebrae,  also  that  the  prominent  lesions  occur  in 
the  neck  from  the  3rd  to  7th  vertebra.  He  notes  a  case  caused 
by  displacement  of  the  right  5th  rib.  An  attack  could  be  caused 
by  irritation  of  this  lesion,  or  be  relieved  at  once  by  replacing  the 
rib. 

The  neck  lesions  seem,  on  the  whole,  to  be  the  most  im- 
portant. Neck  and  spinal  lesion  may  act  by  obstructing  the 
blood-supply  to  brain  or  cord.  They  may  affect  the  cord  di- 
rectly by  mechanical  irritation,  or  may  affect  brain,  cord,  or 
nervous  system  generally  through  the  sympathetics.  In  this 
way  they  may  bring  about  those  morbid  conditions  of  the  cord, 
brain  and  meninges  said  to  cause  the  disease.  While  the  path- 
ology of  epilepsy  is  unknown,  it  yet  appears  that  osteopathic 
lesion  may  account  for  many  of  the  various  conditions  assigned 
as  causes.  Such  lesions,  disturbing  the  sympathetic  system> 


274  PRACTICE  OF  OSTEOPATHY. 

may  act  as  does  peripheral  irritation  from  dentition,  worms, 
cicatrices,  adherent  prepuce,  etc.  Various  of  these  lesions  may 
directly  irritate  peripheral  nerve  structures.  As  traumatism  is 
assigned  as  a  cause,  osteopathic  lesion,  as  cause  or  effect  of  trau- 
matic conditions,  may  be  the  real  cause. 

According  to  Gray,  the  best  accepted  modern  theory  of  the 
cause  of  epilepsy  is  that  it  is  due  to  direct  or  indirect  excitation 
of  the  cortex  or  of  nerve-strands  leading  from  the  cortex  to  the 
the  perpheral  structures;  that  there  is  a  peculiar  condition  of  the 
motor  tract  which  runs  from  the  motor  convolutions  to  the  peripheral 
motor  structures  and  muscles.  He  states  that  we  are  ignorant 
of  the  nature  of  this  molecular  condition;  that  muscles  can  be 
convulsed  only  by  direct  excitation  of  the  muscle  itself,  or  of  the 
motor  tract  leading  from  the  muscle  up  to  the  motor  convolu- 
tions; but  that  some  varieties  of  epilepsy  are  evidently  due  to  an 
excitation  that  extends  into  this  motor  tract  from  some  part  of 
the  nervous  system  beyond  it.  It  would  seem  clear  that  osteo- 
pathic lesion  may  irritate  these  motor  tracts  somewhere  in  their 
course,  as  by  direct  pressure  of  luxated  spinal  vertebrae,  etc., 
or  that  in  a  multitude  of  ways  it  may  produce  excitation  in  some 
other  part  of  the  nervous  system  from  which  it  extends  to  the 
motor  tract.  As  nerve  irritation  by  lesion  is  the  important  point 
in  osteopathic  etiology  generally,  being  well  supported  by  num- 
erous instances  in  which  its  removal  has  cured  the  disease,  it  is  a 
reasonable  conclusion  that  the  various  bony  lesions  found  in 
epilepsy  are  causing  it  by  excitation  of  the  sort  mentioned.  This 
point  is  likewise  supported  by  the  fact  that  removal  of  such  le- 
sion has  often  cured  epilepsy. 

The  PROGNOSIS  is  fair  in  the  ordinary  case,  a  fair  number 
of  the  cases  coming  under  osteopathic  treatment  being  cured 
entirely.  A  large  percentage  not  cured  are  benefited.  There 
seems  to  be  but  little  difference  in  the  prognosis  in  favor  of  petit 
mal.  In  Jacksonian  Epilepsy  the  prognosis  is  not  good. 

TREATMENT:  At  the  time  of  attack  but  little  can  be  done 
for  the  patient.  If  the  patient  can  be  reached  at  the  aura  the 
attack  may  be  prevented  by  pushing  the  patient's  head  strongly 
back  against  a  hand  applying  deep  pressure  in  the  sub-occipital 
fossse.  This  treatment  seems  to  arouse  reflex  stimulation  or  to 


PRACTICE    OF   OSTEOPATHY.  275 

equalize  blood-flow  to  the  brain  by  effect  upon  the  superior  cer- 
vical ganglion  and  medulla. 

Anders  states  that  constriction  of  the  limb  in  which  the  aura 
occurs,  forcibly  moving  the  patient's  head,  placing  snuff  to  the 
patient's  nose,  applying  ice  to  his  spine,  etc.,  will  sometimes 
prevent  the  attack.  McConnell  calls  attention  to  the  fact  that 
in  cases  where  the  exciting  factor  seems  to  be  in  the  intestine 
and  there  is  reverse  peristalsis  of  the  intestines,  causing  a  re- 
version of  the  nerve  current  in  the  vagi,  thorough  rapid  abdom- 
inal treatment  will  normalize  peristalsis  and  aid  in  preventing 
an  impending  attack. 

Stimulation  of  the  solar  plexus  may  lessen  the  attack  by 
calling  the  blood  to  the  intestines  and  thus  reducing  pressure  in 
the  cranium. 

At  the  time  of  the  attack  the  patient  must  be  prevented 
from  having  serious  falls,  if  possible.  The  clothing  about  the 
neck  should  be  loosened  so  that  it  may  not  restrict  circulation. 
Some  object  should  be  slipped  between  the  teeth  to  prevent  the 
patient  biting  his  tongue.  Small  objects  that  may  fall  into  the 
windpipe  should  not  be  used  for  this  purpose. 

A  general  course  of  treatment  is  depended  upon  to  prevent 
recurrence  of  attacks  and  to  cure  the  case.  This  consists  in  the 
removal  of  lesion,  whatever  it  may  be,  and  all  causes  of  reflex 
irritation  mentioned  above.  It  is  especially  important  to  re- 
move lesion  acting  to  irritate  the  motor  fibers  of  the  central 
nervous  system,  in  view  of  the  fact  pointed  out  above  that  such 
excitation  is  probably  the  most  efficient  cause  of  epilepsy.  Treat- 
ment should  be  given  to  correct  blood-flow  to  and  from  the  brain, 
including  such  treatments  as  opening  the  mouth,  against  resist- 
ance, treatments  along  the  course  of  the  carotids,  elevation  of 
the  clavicles,  treatment  of  the  cervical  sympathetics,  etc.  At- 
tention should  be  given  to  upbuilding  the  general  health,  and  to 
keeping  bowels  and  stomach  in  good  condition.  All  causes  of 
worry  or  nerve-strain  should  be  avoided  and  the  patient  should 
lead  an  out-door  life.  The  food  should  be  light  and  easily  di- 
gested, consisting  of  some  meat,  fruit,  vegetables,  cereals,  etc. 
Cold  sponge  baths  are  recommended. 


276  PRACTICE    OF   OSTEOPATHY. 

MIGRAINE,  (Hemicrania,  Sick  Headache)  AND  OTHER 
FORMS  OF  HEADACHE  (Cephalagia). 

DEFINITION:  Migraine  is  "a  neurosis  characterized  by 
severe  attacks  of  headache,  often  paroxysmal  and  more  or  less 
periodic,  with  or  without  nausea  and  vomiting."  It  is  of  ob- 
scure pathology;  there  seems  to  be  nothing  to  connect  it  with 
lesion,  and  from  an  osteopathic  point  of  view  it  is  generally  found 
to  be  due  to  cervical  bony  lesions. 

Headache  is  the  general  term  used  to  describe  pain  in  the 
head.  It  may  be  either  symptomatic  or  idiopathic,  the  latter 
being  generally  chronic  and  due  to  specific  bony  lesion,  usually 
in  the  cervical  vertebrae.  A  large  class  of  the  latter  come  under 
osteopathic  treatment,  generally  in  a  very  bad  condition  after 
having  suffered  far  beyond  the  power  of  drugs  to  cure.  These 
may  almost  be  considered  as  suffering  from  a  hitherto  undes- 
cribed  form  of  headache,  depending  upon  a  specific  lesion,  often 
the  result  of  accident,  and  usually  immediately  relieved  and 
cured  upon  removal  of  the  lesion.  The  form  embraces  many 
of  the  kinds  of  headache  generally  described  under  one  or  other 
of  the  usual  classifications. 

CASES:  (1)  Extremely  severe  frontal  headache  in  a  man 
of  thirty-two,  since  boyhood.  He  had  taken  every  known  remedy 
without  avail.  Lesions  were  found  in  muscular  contractions  on 
the  right  side  of  the  neck;  the  dorsal  spine  was.  anterior  in  its 
upper  half;  the  llth  dorsal  vertebra  was  luxated  to  the  left,  the 
2nd  and  5th  lumbar  vertebrae  were  prominent;  the  sacrum  was 
tilted  forward  and  the  left  innominate  was  slipped,  lengthening 
the  limb.  The  lesions  were  corrected  and  the  case  cured. 

(2)  Migraine  in  a  man  of  thirty,  since  his  sixteenth  year. 
when  he  fell  from  a  wagon.     Lesion  existed  at  the  3rd  cervical 
vertebra  and  at  the  atlas.     The  case  was  relieved  at  once  and 
cured. 

(3)  In  a  boy  of  twelve  a  very  severe  headache  was  caused 
by  a  fall  on  his  head  from  a  bar  in  the  gymnasium.     The  atlas 
was  found  displaced  laterally,  and  the  case  was  cured. 

(4)  In  a  chronic  case  of  occipital   headache  persisting  for 
years,    no    ordinary    remedy    would    affect    the    condition.     The 


PRACTICE    OF    OSTEOPATHY.  277 

atlas  was  found  slipped  and  the  muscles  about  it  very  much 
contracted  and  tender.  Relief  was  given  at  one  treatment,  and 
the  case  was  cured. 

(5)  A  man  of  forty-five,  troubled  for  many  years  by  occipital 
headache,  mostly  upon  the  left  side.     Lesion  was  found  at  the 
atlas,  impinging  upon  a  cervical  nerve.     Cure  was  accomplished 
in  two  months. 

(6)  In  a  lady  of  thirty  there  was  constant  occipito-frontal 
headache.     The  eyes  were  weak  and  painful;  the  glasses  had  been 
changed  six  times  in  one  year.     The  muscles  of  neck  and  shoulders 
were  found  much  contracted,  the  atlas  was  luxated  to  the  right 
and  painful  upon  pressure.     But  one  severe  headache  occurred 
during  one  month's  treatment,  and  the  eyes  were  much  improved. 
In  two  months  the  glasses  were  laid  aside  and  the  headache  was 
cured. 

(7)  Headache,  with  blind  spells,  in  a  woman  of  forty-one; 
the  1st  and  2nd  cervical  vertebra?  were  approximated  and  sore; 
the  muscles  of  the  upper  cervical  region  very  tense;  headache 
constant;  1st  to  8th  dorsal  vertebra  were  flattened  anteriorly; 
llth  dorsal  to  3rd  lumbar  posterior.     The  patient  had  suffered 
a  sunstroke,  and  had  had  two  or  three  attacks  monthly  since. 

(8)  Congestive  headache  in  a  man  of  thirty-seven,  of  twelve 
years  standing.     Violent  attacks  occurred  daily,  and  every  known 
remedy  had  been  used  in  vain.     The  sole  lesion  was  a  depressed 
clavicle  interfering  with  the  venous  flow  from  the  head.     Two 
treatments  restored  the  bone  to  place  and  cured  the  case. 

(9)  Chronic  headache  of  four  years  standing,  caused  by  a 
fall  upon  the  back  of  the  head,  which  rendered  the  neck  partly 
stiff.     There  was   contracture   of  the   tissues   over  the   spinous 
process  of  the  axis,  which  was  displaced  to  the  right.     After  four 
treatments  the  pain  had  disappeared. 

(10)  A  lady  had  for  many  years  suffered    from    agonizing 
headache,  so  severe  at  times  as  to  render  her  unconscious.     For 
some  months  the  head  had  not  ceased  aching,  day  or  night. 
Lesion  was  found  as  slight  luxation  of  the  3rd  and  4th    dorsal 
vertebrae,  and  there  was  a  well  marked  lesion  at  the  llth  and 
12th  dorsal.     The  headache  disappeared  during  one  month  of 
treatment,  with  no  return  after  several  months. 


278  PRACTICE    OF    OSTEOPATHY. 

(11)  A  case  in  which  a  woman  suffered  from  intense  head- 
aches, there  being  also  feeling  of  oppression  at  the  base  of  the 
skull.     The  axis  was  lateral  and  anterior.     The  case  was  cured 
by  adjustment  of  lesions. 

(12)  A   case   of   migraine,   with   chronic   dysentery   of   five 
years  standing,  in  a  man  of  33.     Lesion  was  a  posterior  condi- 
tion of  spine  from  llth  dorsal  to  3rd  lumbar.     The  treatment 
was  directed  to  removal  of  lesion,  curing  the  case. 

(13)  Migraine  of  five  years  standing  in  a  boy  of  16.     The 
3rd  cervical  and  4th  dorsal  vertebras  were  lateral  to  the  right. 
Treatment  was  directed  to  removal  of  lesion,  diet  and  exercise 
also  being  attended  to.     The  case  was  benefited  by  one  treat- 
ment, and  apparently  cured  by  three  treatments.     The  course 
of    treatment    being    continued   once  a  week  for  two  months. 
One   continually  meets  cases  of    severe     chronic   headache    re- 
sulting from  the  use  of  drugs. 

LESIONS:  Migraine,  with  other  forms,  shows  the  usual 
lesions.  Lesions  found  to  produce  it  are  of  the  atlas;  2nd  and 
and  3rd  cervical,  upper  dorsal;  8th,  9th  and  10th  dorsal;  7th  and 
8th  ribs. 

When  headache  is  symptomatic  purely,  lesion  depends  upon 
the  primary  disease,  but  specific  lesion  is  often  present  and  de- 
termines the  effect  in  the  head. 

Atlas,  axis,  cervical,  and,  to  some  extent,  spinal  lesions  are 
the  important  ones  producing  headache.  They  result  in  chronic, 
idiopathic  headaches.  Often  these  may  develop  into  insanity. 

Lesions  act  by  disturbing  sympathetic  relations,  reflexly 
causing  the  headaches,  just  as  may  be  the  case  in  reflex  head- 
ache from  uterine  prolapsus.  They  all  act  by  stoppage  of  blood- 
flow.  This  may  occur  in  several  ways.  The  vertebral  arteries 
may  be  occluded  by  pressure  from  the  displaced  cervical  vertebra ; 
the  clavicle  may  hinder  venous  flow  in  the  external  and  internal 
jugulars,  the  sympathetic  irritation  may  set  up  vaso-motor 
reflexes  and  prevent  proper  circulation.  A  lesion  may  cause 
headache  by  direct  pressure  of  the  luxated  vertebra  upon  a  nerve- 
fibre.  A  very  common  place  for  this  to  occur  is  at  the  atlas 
which  impinges  branches  of  the  suboccipital  nerve  sent  to  supply 
the  occipito-atlantal  articulation.  The  same  thing  is  apt  to 


PRACTICE    OF    OSTEOPATHY.  279 

occur  at  any  of  the  upper  three  cervical  vertebrae,  the  correspond- 
ing nerves  sending  branches  to  supply  sensation  to  the  scalp. 
Contraction  of  tissues  over  branches  of  the  fifth  nerve,  or  at  their 
foramia  of  exit  may  cause  headache.  Reflex  or  direct  irritation 
of  the  fifth  nerve  may  cause  it. 

Lesion  in  the  splanchnic  area  is  often  responsible  for  mi- 
graine. 

The  kinds  of  pain  in  headache  aid  in  diagnosing  the  variety. 
Dana  notes  the  fact  that  a  pulsating  or  throbbing  pain  occurs 
in  headache  due  to  vaso-motor  disturbance,  as  in  migraine;  a 
dull,  heavy  pain  in  toxic  or  dyspeptic  forms;  a  constrictive, 
squeezing,  or  pressing  pain  in  neurotic  or  neurasthenic  cases; 
a  hot,  burning,  or  sore  pain  in  rheumatic  or  anemic  headache; 
a  sharp,  boring  pain  in  hysteric,  epileptic,  or  neurotic  forms. 

The  pain  is  usually  found  to  be  localized  in  or  referred  to 
the  peripheral  ends  of  the  fifth  nerve,  they  supplying  the  antero- 
lateral  parts  of  the  scalp  and  the  dura  mater  with  sentation. 
Hence  treatment  is  directed  to  the  branches  of  the  fifth  nerve 
upon  the  face  and  scalp.  The  chief  local  treatment  in  occipital 
headache  is  made  to  the  upper  four  cervical  nerves,  as  their 
branches  are  here  involved. 

The  PROGNOSIS  is  good  in  all  forms  of  headache,  even  in 
migraine.  The  most  long  standing  and  severe  cases  yield  readily 
to  treatment,  even  when  all  other  remedies  have  failed, 

The  TREATMENT  described  will  apply  to  any  of  the  numer- 
ous kinds  of  headache  described,  though  special  portions  of  the 
treatment  laid  down  may  apply  to  any  given  case  as  sufficient 
for  it.  The  treatment  must  be  adapted  to  the  case,  each  one 
needing  a  special  study  of  its  features  to  enable  one  to  discover 
the  cause  and  apply  the  proper  treatment.  The  treatment  suc- 
cessful in  one  case  may  not  apply  to  another. 

The  lesion  must  be  removed,  and  this  often  constitutes 
the  sole  treatment  necessary.  All  causes  of  irritation  must  be 
removed,  such  as  eye  strain,  sympathetic  disturbance,  uterine 
or  stomach  disease,  etc.  Ordinarily  the  first  step  is  the  relax- 
ation of  contractured  muscles  in  the  neck  and  upper  .dorsal  re- 
gion. These  muscular  contractures  may  often  be  used  as  guides 
to  locate  bony  lesion.  Sometimes  one  small  contractured  fibre 


280  PRACTICE    OF    OSTEOPATHY. 

will  lead  the  examiner  to  the  seat  of  bony  subluxation,  if  care- 
fully followed.  This  relieves  irritation  to  nerves,  frees  circula- 
tion and  prepares  for  the  replacing  of  a  displaced  vertebra.  At- 
tention should  be  given  to  freeing  all  points  of  venous  flow  from 
the  head.  Treatment  may  be  made  in  the  course  of  the  veins 
across  the  forehead  to  the  outer  canthus  of  the  eye  and  down 
toward  the  angle  of  the  jaw,  along  the  jugular  veins,  raising  the 
clavicle  and  relaxing  all  the  tissues. 

Inhibition  along  the  back  and  sides  of  the  neck  in  the  re- 
gion of  the  upper  four  vertebrae,  and  in  the  sub-occipital  fossae, 
quiets  the  upper  four  cervical  nerves  and  aids  in  restoring  equal- 
ity of  circulation  through  affect  upon  the  superior  cervical  gang- 
lion. 

Often  pressure  made  as  follows  is  sufficient:  in  the  mid- 
line  of  the  neck,  just  below  the  occiput ;  below  the  ears,  upon  and 
below  the  transverse  processes  of  the  atlas;  along  the  upper  dor- 
sal region  at  the  upper  three  or  four  vertebrae.  These  treat- 
ments quiet  cerebro-spinal  nerves  and  correct  vaso-motion. 

Treatment  should  be  made  upon  the  face  over  the  points 
of  the  fifth  nerve  (Chap.  V,  B).  Relax  tissues  over  the  nerves 
and  at  the  foramina.  Manipulation  to  relax  the  tissues  all  along 
the  course  of  the  longitudinal  sinus,  from  nasion  to  occipital  pro- 
tuberance, and  thence  laterally  toward  the  mastoid  processes, 
over  the  course  of  the  lateral  sinuses,  aids  in  freeing  the  circula- 
tion in  them.  As  this  treatment  is  carried  over  the  vertex  the 
terminals  of  the  various  sensory  nerves  of  the  scalp  are  affected 
and  quieted. 

Deep  pressure  over  the  solar  plexus,  and  inhibitive  abdom- 
inal treatment,  aid  in  relieving  the  headache  sometimes  by  quiet- 
ing the  reflexes  and  calling  the  blood  away  from  the  head. 

Exciting  causes  should  be  avoided.  It  is  well  in  such  cases 
as  need  it  to  give  attention  to  regulating  the  condition  of  stomach 
and  bowels.  Cold  applied  to  the  forehead  and  temples,  and  heat 
applied  to  the  base  of  the  skull  and  the  extremities,  aid  in  relief. 

LOCOMOTOR  ATAXIA  AND   SPASTIC   PARAPLEGIA. 

DEFINITION:  Locomotor  Ataxia,  or  Tabes  Dorsalis.  is  a 
disease  characterized  by  sclerosis  of  the  posterior  columns  of 


PRACTICE  OF  OSTEOPATHY.  281 

the  cord,  loss  of  cooidination  in  the  muscles  of  the  limbs,  absence 
of  the  patellar  reflex,  lightning  pains  in  the  limbs,  and  the  Argyll 
Robertson  pupil,  which  reacts  to  accommodation  but  not  to 
light. 

CASES:  (1)  In  a  woman  of  thirty-two,  lesions  were  found 
at  the  atlas  and  upper  lumbar  region.  Under  treatment  she 
regained  control  of  the  bladder  and  bowels,  became  able  to  walk 
well,  and  the  progress  of  the  disease  had  apparently  been  termi- 
nated. 

(2)  In   a   man   of   twenty-nine,    the   lesion   was  a    complex 
curvature  of  the  spine.     It  was  lateral  to  the  right  from  the 
5th  dorsal  to  the  2nd  lumbar,  and  posterior  in  the  lower  lumbar 
region,  being  so  marked  that  the  left  lower  ribs  came  within  the 
iliac  fossa,  while  the  right  ones  descended  over  the  hip.     The 
whole  thorax  was  misshaped.     The  right  limb  was     atrophied 
to  one-half  its  original  size.     After  eight  months  treatment  the 
patient  could  walk  thirty-five  blocks  without  a  cane;  his  general 
health  was  good  and  the  disease  was  showing  raid  improvement. 

(3)  A  case  in  a  young  man  of  twenty,  in  which  there  was 
marked  scoliosis  of  the  dorsal  spine,  involving  the  thorax,  some 
improvement  in  the  locomotor  ataxia  was  gained  urider  treat- 
ment. 

(4)  A  case  in  a  man  of  thirty-five  showed  spinal  lesion  in 
the  dorsal  spine  between  the  shoulders,  the  vertebrae  being  irreg- 
ular and  posterior.     Under  continued  treatment  his  walking  was 
much  improved,  visceral  crises  were  prevented,  the  control  of 
the  bladder  and  rectum  were  regained,  and  the  pains  in  the  lower 
limbs  were  done  away. 

(5)  A  case  presented  spinal  lesion  in  the  form  of  a  too  great 
anterior  sweep  of  the  lumbar  region  of  the  spine. 

(6)  Locomotor  Ataxia  of  a  severe  form,  of  four  years  dura- 
tion.    The  eyes  had  become  so  bad  that  patient  could  not  read, 
and  could  scarcely  distinguish  light  from  dark.     Lesion  was  found 
at  the  1st  and  2nd  cervical,  4th  and  5th  dorsal,  posterior  condi- 
tion of  the  lower  dorsal  and  upper  lumbar  spine,  and  lateral  les- 
ion at  the  5th  lumbar.     Gradual  improvement   took  place  under 
treatment,  a  considerable  gain  having  been  made  at  the  time  of 
the  report. 


282  PRACTICE    OF    OSTEOPATHY. 

SPASTIC  PARAPLEGIA  (Spastic  Spinal  Paralysis)  is  a  cord 
disease  with  loss  of  muscular  power,  exaggerated  patellar  re- 
flexes, a  peculiar  gait,  and  precipitate  micturition.  It  is  a  pri- 
mary sclerosis  of  the  cord. 

CASE:  A  middle-aged  man,  after  injury  to  the  spine  in  a 
mine  accident,  was  affected  with  complete  motor  and  sensory 
paraplegia.  Operation  for  supposed  fracture  of  the  7th  dorsal 
vertebra  removed  pressure  and  restored  sensation  for  the  greater 
part.  Spastic  paraplegia  developed.  The  lesions  were  found 
to  be  a  posterior  7th  dorsal  vertebra;  8th,  9th  and  10th  posterior 
and  toward  the  left.  Considerable  improvement  was  made  under 
treatment. 

LESIONS  in  both  of  these  diseases  are  found  at  various  places 
along  the  spine.  In  spastic  paraplegia  they  are  generally  in  the 
lower  dorsal,  lumbar  and  sacral  regions. 

In  locomotor  ataxia  spinal  curvature  is  often  found  as  the 
cause.  Derangement  of  the  thoracic  vertebrae  in  the  region  be- 
tween the  shoulders  often  causes  it.  Atlas,  cervical,  and  lum- 
bar lesions  are  often  found.  Dr.  Still  points  out  lesion  of  the 
sacrum  as  the  cause  'of  locomotor  ataxia. 

The  PROGNOSIS  in  neither  disease  is  promising  as  to  cure. 
Most  cases  are  benefited,  some  to  a  marked  extent.  Locomotor 
ataxia  is  more  frequently  met  with  and,  on  the  whole,  more  suc- 
cessfully treated.  The  progress  of  the  disease  is  often  checked; 
control  of  bladder  and  rectum  are  established ;  the  power  of  walk- 
ing, even  after  complete  loss  in  some  cases,  is  restored.  These 
These  cases  are  generally  benefited,  but  sometimes  do  not  yield 
to  treatment.  In  cases  of  spastic  paraplegia  the  sum-total  of 
results  is  not  so  great.  The  walking  is  often  improved,  and  pre- 
cipitate micturition  is  bettered. 

The  sclerotic  changes  in  the  cord  in  these  diseases  render 
them  incurable,  even  after  removal  of  specific  lesion,  yet  the 
sclerotic  process  is  doubtless  often  checked  by  the  removal  of 
lesion  and  the  attendant  treatment. 

A  few  cases  of  both  diseases,  in  early  stages  and  resulting 
from  injury,  are  reported  cured. 

The  TREATMENT  of  locomotor  ataxia  consists  in  the  removal 
of  lesion  and  general  spinal  treatment.  The  removal  of  lesion 


PRACTICE    OF    OSTEOPATHY.  283 

is  insufficient.  The  thorough  spinal  treatment  must  be  made 
to  influence  spinal  nerve  connections,  the  central  distribution  of 
the  sympathetics,  and  the  blood-circulation  about  and  to  the 
spine.  This  treatment  should  be  given  especially  from  the  mid- 
dle dorsal  down,  as  the  degenerative  changes  in  the  cord  and 
meninges  begin  in  the  lower  part.  If  the  ataxic  condition  has 
not  yet  appeared  in  the  arms,  and  cerebral  symptoms  have  not 
developed  the  indications  are  especially  for  treatment  to  the 
lower  spine.  Treatment  to  the  upper  spinal  and  cervical  regions 
should  be  given,  however,  at  any  stage,  to  limit  or  prevent  the 
spread  of  the  pathological  cord  changes  in  these  regions. 

The  nerve-supply  to  the  limbs,  upper  and  lower,  as  well 
as  the  limbs  themselves,  should  be  treated.  Care  must  be  taken 
in  this  matter,  as  the  tendency  of  the  long  bones  to  fracture  is 
marked  in  locomotor  ataxia.  The  arthropathies,  if  present,  call 
for  special  treatment  to  the  joint  involved,  and  its  nerve  and  blood- 
supply.  As  the  knee-joints  are  most  frequently  attacked,  the 
treatment  to  the  lower  limbs  wll  serve  to  lessen  the  danger  of 
their  occurrence.  The  spinal  treatment  should  include  spring- 
ing the  spine,  and  various  other  methods  of  separating  the  verte- 
brae from  each  other,  increasing  circulation  about  them  and 
keeping  up  their  nutritive  integrity,  as  the  articular  surfaces  and 
interarticular  fibro-cartilages  are  liable  respectively  to  absorption 
and  atrophy. 

Abdominal  treatment  should  be  maintained  to  prevent 
visceral  crises,  most  common  about  the  stomach.  Treatment 
should  be  upon  the  abdominal  nerve-plexuses  and  blood-circu- 
lation. The  stomach  and  bowels  may  thus  be  kept  in  good  con- 
dition. Lumbar  and  sacral  treatment,  together  with  treatment 
to  the  internal  iliac  blood-vessels  from  the  abdominal  aspect, 
aid  in  restoring  the  sphincters  of  bladder  and  rectum  to  good  con- 
ditions. In  case  of  necessity  the  cathseter  should  be  used  to 
empty  the  bladder.  To  relieve  the  lightning  pains  in  the  limbs 
strong  inhibition  should  be  made  upon  the  anterior  crural  nerve 
in  Scarpa's  triangle;  upon  the  great  sciatic  at  the  back  of  the 
thigh  between  the  tuberosity  and  the  great  trochanter,  slightly 
nearer  the  latter;  and  upon  the  lumbar  and  sacral  portions  of 
the  spine. 


284  PRACTICE    OF    OSTEOPATHY. 

The  treatment  of  spastic  paraplegia  proceeds  upon  the  same 
lines  as  the  general  treatment  for  locomotor  ataxia,  including 
removal  of  lesion,  thorough  general  spinal  treatment,  and  treat- 
ment of  the  lower  limbs.  The  spasticity  in  the  latter  sometimes 
hinders  treatment,  but  may  be  overcome  by  inhibition  of  the 
-anterior  crural  and  sciatic  as  above. 

Other  forms,  such  as  Secondary  Spastic  Paralysis,  in  which 
the  symptoms  are  not  so  well  marked;  Congenital  Spastic  Par- 
aplegia, usually  due  to  injury  at  birth;  Ataxic  paraplegia,  com- 
bining spastic  and  ataxic  features,  retaining  the  reflexes;  and  the 
Combined  System  Sclerosis,  Disseminated  Sclerosis,  etc.  are 
approached  in  the  same  manner  for  discovery  of  lesions  and  treat- 
ment. 

PARALYSIS  AGITANS. 

(PARKINSON'S  DISEASE.     SHAKING  PALSY). 

DEFINITION:  A  chronic  disease,  in  which  there  is  tremor, 
peculiar  character  of  speech  and  gait,  and  progressive  loss  of 
muscular  power. 

The  LESIONS  found  in  this  disease  usually  occur  in  the  cer- 
vical and  upper  dorsal  region,  and  among  the  upper  ribs.  These 
lesions,  being  present,  doubtless  determine  the  victim  of  the  dis- 
ease. 

It  occurs  in  those  whose  central  nervous  system  is  thus 
weakened  and  laid  liable  to  the  action  of  such  secondary  causes 
as  exhausting  illness,  mental  strain,  worry,  traumatism,  etc. 
The  latter  may  directly  result  in  such  lesions.  The  fact  that  the 
pathology  of  the  disease  is  obscure,  it  being  by  many  regarded  as 
a  functional  disturbance,  and  the  further  fact  that  the  causes 
are  not  well  known,  lends  color  to  the  theory  that  such  lesions  as 
are  recognized  by  Osteopathy,  being  always  such  as  are  not  sought 
for  by  the  regular  practitioner,  are  the  real  causes  of  the  condi- 
tion. They  occur  high  in  the  spine,  at  a  point  where,  acting  upon 
the  central  nervous  system,  they  could  produce  the  effect  in  the 
whole  body,  as  noted  in  the  tremor  of  both  upper  and  lower  limbs, 
as  well  as  of  the  head  sometimes. 

The  PROGNOSIS  :  There  is  a  reasonable  expectation  of  limiting 
the  progress  of  the  disease  and  bettering  the  patient's  general  condi- 


PRACTICE  OF  OSTEOPATHY.  285 

tion.  The  fact  that  there  is  no  pathological  change  in  the  cord,  and 
that  the  disease  is  probably  functional,  leaves  ground  for  hope 
that  very  much  benefit,  perhaps  cure,  can  be  attained  under 
osteopathic  treatment.  A  number  of  cases  have  been  cured. 

The  practitioner  must  bear  in  mind  that  it  is  a  feature  of 
the  disease  for  the  patient  to  sometimes  be  better,  and  he  must 
not  too  strongly  encourage  the  patient  when  such  a  period  oc- 
curs, without  reason  to  expect  the  permanence  of  such  gain. 

The  TREATMENT  consists  in  removal  of  lesion;  the  thor- 
ough relaxation  of  all  spinal  and  cervical  muscles,  particularly 
apt  to  be  set  and  hardened  about  the  neck  and  shoulders;  and  a 
most  thorough  general  spinal  treatment.  Particular  attention 
should  be  paid  to  the  condition  of  the  nerve-plexuses  supplying 
the  upper  and  lower  limbs.  These,  and  the  circulation  to  the 
limbs,  should  be  strongly  stimulated.  The  general  health  is 
usually  good,  but  it  is  not  amiss  to  keep  bowels,  kidneys  and 
liver  stimulated. 

Light  exercise  and  baths  are  good  for  the  case. 

OCCUPATION  NEUROSES. 

DEFINITION:  A  neurosis  due  to  constant  use  of  certain 
groups  of  muscles  in  occupations  which  necessitate  delicate 
movements,  resulting  in  cramp,  spasm,  paralysis,  tremor,  or 
neuralgia,  and  due  to  specific  lesion  to  the  nerves  supplying  the 
affected  groups  of  muscles. 

The  very  numerous  varieties  of  this  disease,  various  forms 
of  musician's  cramp,  telegrapher's  seamstress',  driver's,  milker's, 
cigar-maker's,  etc.,  are  all  manifestations,  more  or  less  severer 
of  obstruction  to  the  nerves  supplying  the  parts  involved.  These 
obstructions  generally  act  upon  the  nerve-supply  of  the  upper 
limbs,  but  in  a  few  varieties,  as  in  ballet-dancers  and  tailors, 
those  of  the  lower  limbs  may  be  involved. 

CASES:  Numerous  cases  of  telegrapher's,  writer's  and 
pianist's  paralysis  are  known  and  recalled  in  this  connection, 
although  the  data  as  to  lesions,  etc.,  are  not  now  available. 
These  cases  were  generally  cured.  The  following  cases  are  typical. 

(1)  A  marked  case  of  telegrapher's  paralysis,  of  three  years 
standing.  For  two  years  the  hands  had  been  almost  useless, 


"286  PRACTICE   OF    OSTEOPATHY. 

and  the  patient  could  not  distinguish  by  touch  between  an  ink- 
stand and  a  pencil,  sensation  and  motion  were  both  much  im- 
paired. The  lesions  were  found  in  the  1st,  2nd,  and  3rd  right 
ribs  being  close  together;  the  clavicle  down  upon  the  right  first 
rib,  and  the  cervical  origin  of  the  brachial  plexus  covered  with 
much  contractured  muscles.  After  one  months  treatment  the 
patient  could  write  his  name.  In  six  weeks  he  could  distinguish 
between  coins  by  touch,  and  in  three  months  the  case  was  cured. 

(2)  Pianist's  paralysis,  showing  lesions  in  the  upper  dorsal 
spine. 

(3)  Pianist's  paralysis,  showing  lesions  in  the  cervical  and 
upper  dorsal  regions  of  the  spine,  depression  of  both  clavicles, 
and  contracture  of  muscles  in  the  posterior  cervical,  upper  dor- 
sal and  shoulder  regions. 

(4)  Penman's  paralysis  in  a  man  of  35,  of  three  years  stand- 
ing.    The  3rd  cervical  to  the  5th  dorsal  region  of  the  spine  was 
lateral  to  the  right.     The  case  was  cured  in  two  months  by  cor- 
rection of  lesion  and  treatment  of  the  circulation  to  the  arm. 

(5)  Pianist's  cramp  in  a  woman  of  25.     There  was  a  slip 
of  the  sternal  end  of  the  clavjcle,  and  slight  deviation  of  the  3rd, 
4th.   and   5th   cervical  vertebrae.     The   condition   was   of   three 
years  duration.     The  case  was  benefited  after  second  treatment, 
and  was  cured  in  one  month.     This  case  had  been  diagnosed  as 
"tuberculosis  of  the  bone, "  and  amputation  had  been  advised. 

The  LESIONS  in  these  cases  are  doubtless  often  directly  due 
to  the  occupation.  Case  (1)  above  is  a  good  illustration  of  the 
result  of  an  occupation  requiring  the  elevation  of  the  right  shoulder 
resulting  in  drawing  together,  the  upper  three  ribs,  and  in  approx- 
imating the  clavicle  and  first  rib  in  such  a  manner  as  to  bring 
pressure  upon  the  brachial  plexus.  A  faulty  posture,  involving 
bad  position  of  the  shoulder,  neck  and  upper  spine,  is  quite  as 
likely  to  result  in  bony  lesions  in  these  parts  as  is  faulty  posture 
to  result  in  spinal  curvature. 

In  a  certain  number  of  cases  the  lesions  are  likely  present 
in  the  spine  and  other  parts,  and  determine  an  early  break-down 
in  the  anatomical  parts  concerned  in  the  occupation,  from  over- 
use. Over-use  of  an  arm,  as  in  writing,  no  doubt  plays  its  part 
in  wearing  out  the  nerve-mechanism,  but  the  fact  that  many 


PRACTICE  OF  OSTEOPATHY.  287 

young  people  suffering  from  an  occupation  neurosis  are  found  to 
have  these  lesions,  while  many  other  persons  labor  assiduously 
for  years  at  the  same  occupations  without  disability  indicates 
that  the  lesions  behind  the  excessive  use  is  the  real  cause  of  the 
trouble.  Use  of  the  arm  is  really  excessive  only  in  proportion  as 
the  parts  do  not  recuperate  after  use.  The  lesion  to  nerve-sup- 
ply prevents  proper  recuperation,  and  the  arm  wears  out  because 
of  the  presence  of  lesion. 

In  pianist's  spinal  disease  is  often  found  to  be  due  to  sit- 
ting for  hours  at  the  instrument.  It  may  as  reasonably  cause 
spinal  lesions  of  a  nature  to  result  in  the  neurosis  of  the  arms. 
That  central,  i.  e.,  spinal,  lesion  is  present  is  indicated  by  the 
fact  that  in  penman  who  learn  to  write  with  the  left  hand  after 
an  attack  of  paralysis  in  the  right  the  disease  usually  soon  makes 
its  appearance  in  that  member  also.  In  pianist's  the  trouble  is 
generally  from  spinal  lesion. 

Lesions  may  occur  high  in  the  cervical  region,  but  such  is 
not  likely  to  be  the  case.  Lesions  from  the  origin  of  the  brachial 
plexus  to  the  sixth  dorsal  vertebra  are  met  with.  Most  com- 
monly the  lesion  lies  between  the  fifth  cervical  and  fourth  dorsal, 
favoring  a  position  still  lower  in  the  cervical  and  about  the  upper 
three  or  four  dorsal.  Lesion  of  the  clavicle  and  upper  two  ribs, 
especially  upon  the  right  side,  are  very  common.  It  is  readily 
seen  from  the  nature  of  the  causes  producing  lesion  that  the  ribs 
below  the  upper  two  may  be  involved.  Ribs  and  vertebrae  as 
low  as  the  5th  or  6th  may  be  luxated  and  cause  the  trouble. 
Vaso-motor,  secretory  and  trophic  affections  occur  in  the  affected 
member.  Vaso-motors  to  the  arms  are  found  as  low  as  the  first 
thoracic  ganglion,  or  lower.  The  connection  of  the  intercostal 
nerves  with  the  sympathetic  system  may  explain  why  rib  lesions 
this  low  may  cause  the  trouble.  The  first  and  second  intercostal 
nerves  are  connected  with  the  brachial  plexus.  They  are  often 
impinged  by  the  corresponding  ribs  in  these  troubles.  McConnell 
calls  attention  to  the  fact  that  slight  luxations  of  shoulder  and 
elbow-joints  may  cause  this  disease.  In  such  case  the  affect 
would  probably  be  through  lesion  to  the  articular  branches  sup- 
plied from  the  brachial  plexus. 

While  Dana  states  that  this  condition  is  "a  neurosis  having 


288  PRACTICE    OF    OSTEOPATHY. 

no  appreciable  anatomical  basis,"  it  seems  from  the  results  gotten 
by  the  removal  of  lesion  that  Osteopathy  discovers  the  real 
anatomical  cause  of  the  disease. 

The  PROGNOSIS  is  good.  Even  the  worst  cases  are  cured. 
Cure  is  the  rule,  though  some  cases  may  be  intractable. 

TREATMENT:  The  removal  of  lesion  as  the  direct  cause, 
as  in  displacement  of  the  clavicle  onto  the  brachial  plexus,  is 
often  the  only  treatment  necessary.  The  nerve  and  blood-sup- 
ply of  the  affected  part  should  be  kept  free  by  treatment  upon 
them,  and  by  relaxation  of  all  contractured  muscles  and  hardened 
tissues.  The  arms  should  be  stretched  and  treated  as  described 
in  Chap.  X.  The  brachial  plexus  may  be  stimulated  on  the 
inner  side  of  the  arm  just  below  the  axilla,  and  in  the  neck  be- 
hind the  clavicle.  Treatment  should  be  carried  up  along  the 
plexus  to  the  spine.  The  elbow  and  shoulder  joints  should  be 
sprung  and  adjusted  if  necessary.  (Chap.  X.) 

It  may  be  necessary  to  have  the  patient  rest  from  his  occu- 
pation during  the  treatment,  particularlyi  at  first  for  a  few  weeks. 
This  matter  depends  upon  conditions.  Some  cases  have  been 
cured  while  the  customary  work  is  continued.  In  some  cases 
it  is  well  to  give  a  general  treatment  to  the  nervous  system,  as 
nervous  symptoms  may  appear.  Vertigo  and  insomnia  are  some- 
times present,  doubtless  due  to  the  upper  spinal  lesions  affect- 
ing the  blood-circulation  to  the  brain. 

Local  work  should  be  carried  over  the  brachial  artery,  and 
over  the  fore-arm  and  hand.  This  increases  local  circulation 
and  does  away  with  the  local  congestion  and  secretory  disturb- 
ance found  in  the  affected  members.  It  may  be  useful  for  the 
patient  to  develop  the  arms  by  systematic  gymnastics.  The 
various  mechanical  appliances  used  to  lessen  the  work  upon  the 
affected  muscle  groups  and  to  call  into  play  other  and  larger 
groups,  may  be  useful  if  the  patient  finds  it  necessary  to  continue 
his  occupation.  Sleeves  that  interfere  with  free  motion  of  the 
hand  in  writing,  cuffs  that  bind  the  wrist,  constricting  bands  that 
may  be  used  as  sleeve  supporters,  and  any  agency  limiting  mo- 
tion and  circulation  must  be  avoided.  Systematic  gymnastics 
of  the  hand  and  arm  are  helpful  in  developing  proper  circulation, 
also  in  upbuilding  neglected  muscles. 


PRACTICE    OP    OSTEOPATHY.  289 

The  pain  frequently  present  in  arms  and  shoulders  may  be 
quieted  by  inhibition  of  the  plexus  arid  its  spinal  origin,  but  gen- 
erally yields  to  the  general  process  of  relaxing  muscles,  etc. 

NEURASTHENIA. 

(Nervous  Prostration.) 

DEFINITION:  "A  functional  disease  of  the  nervous  system, 
characterized  by  mental  and  bodily  weakness."  It  is  not  a 
psychosis.  There  is  functional  exhaustion  and  irritatability  of 
the  nerve  centers. 

(1)  In  a  woman  of  thirty-two,  neurasthenia  developed  after 
confinement   and  sickness.     Symptoms  of  the  disease  were  all 
very  well  marked.     Lesions  were  found  in  a  displacement  of  the 
third  cervical  vertebra  to  the  right,  general  depression  of  the 
ribs,  separation  of  the  llth  and  12th  dorsal  yertebrae,  a  posterior 
luxation  of  the  fifth  lumbar  vertebra,  and  contracture  of  the 
lumbar  muscles.     The  neurasthenia  was  apparently  reflex  from 
uterine  disease.     Two  weeks  daily  treatment  re-established  men- 
struation,  which  had  been   suppressed  for  some  time.     Under 
one  months  treatment  all  the  symptoms  had  disappeared. 

(2)  A  case  of  neurasthenia  in  a  lady  of  sixty,  following  over- 
work and  runaway  accident.     The  whole  spine  and  body  was 
hyperesthetic,  the  spinal  tissues,  from  occiput  to  sacrum,  were 
exceedingly    tense.     Treatment    was    beneficial    from    the    first. 
One  years  treatment  produced  great  improvement. 

(3)  In  a  lady  of   fifty,  with  uterine  disease,  lesions  were 
found  in  a  posterior  luxation  of  the  atlas  and  depression  of  all 
the  ribs,  narrowing  the  thorax.     The  patient  was  benefited. 

(4)  Traumatic    neurasthenia    developed    after    the    patient 
was  thrown  from  a  buggy.     Lesion  was  found  in  a  slip  at  the 
fourth  lumbar  and  marked  lateral  luxation  of  the  tenth  dorsal 
vertebra.     The  spinal  lesion  was  corrected  in  three  weeks,  but 
no  improvement  occurred  in  the  patient's  general  condition  until 
ten  weeks  treatment  had  been  taken.     After  two  weeks  further 
treatment  the  case  was  well. 

(5)  Nervous  exhaustion  in  a  man  who  had  been  suffering 
from  kidney  disease.     The  whole  spine  was  rigid,  with  its  muscles 
and  ligaments  all  tense.     Pus  and  phosphates  appeared  in  the 


290  PRACTICE    OF    OSTEOPATHY. 

urine.     During  3^  months  treatment  the  patient  gained  12  lbsv 
the  urine  cleared,  and  the  case  was  cured. 

(6)  Nervous  prostration  of  four  years  standing  in  a  woman 
of  42.  Many  minor  lesions  occurred  along  the  spine,  especially 
the  3rd  and  4th  cervical  vertebrae  were  lateral,  the  6th  cervical 
posterior,  a  general  posterior  condition  of  the  dorsal  region,  the 
4th  and  5th  lumbar  lateral,  the  coccyx  anterior,  the  left  innom- 
inate up  and  back.  There  was  a  prolapsed  uterus,  dysmenorrhoea, 
enlarged  liver  and  spleen.  The  case  was  cured  in  three  months. 

The  LESIONS  found  in  neurasthenia  are  general  spinal  le- 
sions. Different  cases  present  different  lesions,  and  no  typical 
lesion  may  be  described  for  all  cases.  Yet  perhaps  a  majority 
of  these  cases  show  a  depression  of  all  of  the  ribs,  narrowing  the 
thorax  and  often  causing  enteropsis.  Floating  kidney  and  en- 
teroptosis  are  well  known  as  causes  of  neurasthenia.  There  is 
no  doubt  that  many  cases  of  neurasthenia  apparently  thus  caused 
are  really  due  to  bad  spinal  condition  and  flattening  of  the  thorax 
through  depression  of  all  the  ribs.  These  extensive  lesions  affect 
cerebro-spinal  system  directly,  also  the  sympathetic  system,  thus 
causing  the  neurasthenia  and  the  enteroptosis. 

Often  the  lesion  in  these  cases  is  such  as  produce  disease 
in  some  organ,  secondary  to  which  neurasthenia  is  developed. 
This  is  well  illustrated  in  these  lower  spinal  lesions  producing 
uterine  disease,  from  which  neurasthenia  is  reflexly  caused. 
Thus  a  variety  of  lesions  may  be  found  in  neurasthenia,  dif- 
ferent cases  presenting  different  lesions.  Each  case  demands  an 
individual  study.  For  the  production  of  neurasthenia  there  is 
necessary  merely  a  lesion  producing  an  irritation  upon  the  nerve 
system,  reflexly  or  directly,  allowing  a  leakage  of  nerve-force, 
and  determining  the  victim  of  neurasthenia  from  overwork,  worry, 
uterine  disease,  naso-pharyngeal  disease,  the  use  of  coffee,  aico- 
hol,  etc. 

The  different  varieties  of  neurasthenia  may  be  caused  by 
the  predominance  of  lesion,  e.  g.,  the  cerebral  type  by  upper  dorsal 
and  cervical  lesions,  the  gastric  by  splanchnic  lesions,  the  lithemic 
by  lower  dorsal  and  upper  lumbar  lesions,  etc.  Influenza,  a 
common  cause  of  this  disease,  is  a  malady  particularly  noted  by 
osteopathy  as  producing  serious  spinal  lesions,  mostly  in  the 


PRACTICE    OF    OSTEOPATHY.  291 

shape  of  contracted  muscles  and  tenseness  of  the  other  tissues, 
but  sometimes  actual  bony  lesions  by  drawing  parts  out  of  place 
through  contracture  of  attached  tissues.  Lesion  thus  produced 
may  cause  neurasthenia.  It  is  common  as  the  result  of  trauma- 
tism,  such  as  caused  by  railway  accidents,  bony  lesions  thus  being 
produced  as  irritants  to  nerves. 

The  PROGNOSIS  for  cure  is  good.  Those  cases  that  have 
not  yielded  to  any  of  the  usual  modes  of  treatment  often  readily 
yield  to  osteopathic  treatment.  The  best  of  results  may  be  ex- 
pected in  the  worst  cases.  Cases  are  often  quickly  cured  if  gotten 
in  the  early  stages.  The  average  case  demands  a  somewhat  long 
course  of  treatment,  varying  from  a  few  months  to  a  year  or 
more. 

The  TREATMENT  must  be  adapted  to  the  case  in  hand  after 
a  special  study  of  its  peculiarities  and  requirements.  The  re- 
moval of  every  source  of  reflex  irritation  is  neccessary,  but  these 
sources  must  be  studied  out  in  each  individual  case,  The  le- 
sions present  should  be  removed,  but  the  case  is  not  always  at 
once  benefited  thereby,  as  a  course  qf  treatment  is  generally  neces- 
sary to  recuperate  the  exhausted  nerve-centers.  Consequently 
a  most  systematic  and  thorough  course  of  treatment  must  be 
devoted  to  this  end.  The  various  spinal  treatments  as  described, 
for  relaxation  of  all  spinal  tissues,  springing  the  vertebrae  apart 
for  freedom  of  circulation  and  stimulation  of  the  spinal  nerve- 
system  and  the  circulation  thereto,  are  -given  to  increase  nutri- 
tion of  the  nervous  system  and  upbuild  the  exhausted  centers. 
This  spinal  treatment  affects  the  sympathetic  system  markedly. 
Cervical  treatment  is  also  important  in  this  connection.  Good 
results  are  usually  at  once  apparent  in  relief  of  nerve-tension, 
reduction  of  irritability,  and  correction  of  function. 

Special  manifestations  of  the  condition,  as  heada'che,  in- 
somnia, vertigo,  etc.,  call  for  cervical  treatment  particularly. 
Bowels,  kidneys,  liver,  etc.,  must  be  carefully  looked  after  to  re- 
lieve constipation,  lithemia,  anorexia  and  other  such  symptoms 
usually  present.  A  thorough  general  treatment  of  the  whole 
body  is  not  amiss  in  these  cases. 

The  patient  must  be  kept  free  from  excitement  and  from 
all  causes  of  drain  upon  the  nervous  vitality.  The  diet  should 


292  PRACTICE   OF   OSTEOPATHY. 

be  light  and  nutritious.  The  use  of  cold  sponge  or  shower  baths; 
etc..  will  aid  him  to  preserve  a  cheerful  state  of  mind.  Some 
cases  may  be  treated  daily  with  advantage,  in  the  beginning  of 
treatment.  Later,  the  treatments  may  be  decreased  in  number 
to  three  or  two  per  week. 

HYSTERIA. 

This  is  a  condition  frequently  met  and  treated  osteopath- 
ically.  One  needs  to  be  continually  upon  guard  against  its  sim- 
ulation of  other  conditions,  being  equally  careful  not  to  over- 
look other  diseases  because  of  a  hurried  diagnosis  of  hysteria. 
Being  a  functional  disease  of  the  nervous  system,  and  a  psychosis, 
it  is  frequently  found  to  depend  upon  some  spinal  bony  lesion 
acting  as  the  cause  disturbing  the  nervous  equilibrium.  The 
lesion  varies.  One  cannot  expect  a  certain  kind  of  lesion  in  these 
cases,  but  generally  finds  some  actual  derangement  which  is, 
at  bottom,  responsible  for  the  altered  nerve-conditions,  making 
it  possible  for  a  neurotic  disposition,  infectious  fevers,  poisons 
of  various  kinds,  emotional  disturbances,  mental  or  physical 
strain,  and  other  causes  to  result  in  hysterical  attacks. 

Dr.  Still  calls  attention  to  the  fact  that  in  hysteria  the  lower 
ribs  are  often  displaced  downward,  and  the  colon  is  prolapsed  in  the 
pelvis.  He  raises  the  ribs,  draws  up  the  intestine  and  corrects 
the  circulation  to  the  genitals. 

Correction  of  lesion  removes  the  primary  cause  of  irrita- 
tion to  the  nervous  system,  perhaps  cures  a  certain  disease  to 
which  the  hysteria  is  secondary,  and  this  is  an  important  step 
in  the  radical  cure  of  the  condition. 

The  PROGNOSIS  for  cure  is  good.  The  treatment  relieves 
nervous  tension  and  quiets  the  overwrought  system  at  once. 

In  the  TREATMENT  considerable  tact  must  be  used.  The 
primary  treatment  embraces  the  removal  of  all  lesions  and 
causes  of  irritation.  A  course  of  treatment  for  the  general  ner- 
vous system  must  be  carried  through.  The  general  treatment 
as  described  for  upbuilding  the  nervous  system  in  neurasthenia 
would  be  applicable  here. 

During  an  hysterical  attack  the  practitioner  must  use  great 
firmness,  but  not  violence,  with  the  patient.  He  must  gain 


PRACTICE   OF    OSTEOPATHY.  293 

mental  and  moral  control,  and  while  applying  a  general  relax- 
ing and  inhibitive  spinal  and  cervical  treatment  to  relieve  nerve- 
tension  and  to  quiet  the  nervous  system,  by  a  strong  show  of 
authority  compel  the  patient  to  cease  various  motions,  unbend 
a  clenched  hand,  stop  incoherent  talking,  etc.  Sometimes  a 
dash  of  cold  water  upon  the  face  or  abdomen,  or  pressure  over 
the  ovaries  will  end  the  attack.  All  sympathetic  friends  must 
be  dismissed  from  the  room,  and  moral  suasion,  with  isolation 
of  the  patient,  be  tried.  The  practitioner  must  gain  the  patient's 
confidence.  Hysterical  joints,  hysterical  pains,  contractures, 
eye-symptoms,  paralysis,  etc.,  call  for  no  special  treatment;  all 
disappear  upon  regulation  of  the  mental  condition  and  upbuilding 
of  the  general  nervous  system. 

Many  chronic  cases,  as  in  bed-ridden  hysterics,  must  be 
carried  through  a  course  of  education  in  performing  simple  mo- 
tions and  acts  which  they  thought  beyond  their  power.  The 
patient  should  lead  a  regular  life,  and  her  mind  should  be  kept 
occupied  by  some  engrossing  occupation. 

Judicious  management  of  the  case,  authority  over  the  pa- 
tient, and  a  careful  general  treatment  for  the  health  of  the  body 
and  particularly  of  the  nervous  system,  will  be  successful  in  the 
majority  of  cases. 

INSOMNIA. 

DEFINITION:  'Incomplete,  disturbed,  or  lacking  sleep.  A 
condition  frequently  idiopathic  and  caused  by  specific  lesions, 
usually  bony.  Idiapathic  insomnia  embraces  many  forms  gen- 
erally looked  upon  as  symptomatic  or  secondary.  Many  really 
symptomatic  or  secondary  cases  are  noted,  especially  in  nervous 
diseases,  the  primary  condition  itself  being  usually  found  to  de- 
pend, at  bottom,  upon  bony  lesion. 

CASES:  Very  numerous  cases  are  met  and  treated  osteo- 
pathically.  The  following  cases  illustratrate  various  points  in 
connection  with  such  cases: 

(1)  Insomnia,  nervousness  and  complication  of  troubles. 
Sleep  could  not  be  induced  by  the  most  powerful  soporifics.  Le- 
sion was  found  among  the  cervical  and  upper  dorsal  vertebrae. 
The  case  was  cured  in  two  months  treatment. 


294  PKACTICE    OF    OSTEOPATHY. 

(2)  Insomnia    and    general    nervousness,    pronounced    in- 
curable.    The  patient  had  had  no  good  nights  sleep  in  fiveyears> 
and  had  become  a  nervous  wreck.     Lesion  was  found  in  the  shape 
of  contractured  condition  of  all  the  cervical  muscles. 

(3)  A  case  of  several  years  standing,  in  which  the  lesion 
affected  the  atlas,  which  was  displaced  a  little  to  the  right,  was 
cured  by  the  correction  of  the  lesion  in  six  treatments. 

(4)  A   case  of  insomnia  as  an  accompaniment  of  neuras- 
thenia, in  which  the  patient  had  depended  upon  soporifics  for 
a  number  of  years,  slept  well  after  the  second  or  third  treatment. 
The  use  of  artificial  aid  to  sleep  was  necessary  but  at  rare  inter- 
vals thereafter.     The  case  was  practically  cured  at  the  time  of 
report. 

(5)  A  case  of  insomnia  of  some  years  standing,  due  to  cer- 
vical and  upper  dorsal  lesions,  cured  in  six  months  treatment. 

(6)  A  case  of  three  years  standing,  in  which  the  heart-beat 
had  become  very  irregular  from  the  resulting  nervousness.     Four 
treatments  corrected  the  heart  beat,  and  the  case  had  been  prac- 
tically cured,  at  the,  time  of  report. 

(7)  A  case  of  insomnia  with  constipation  and  amenorrhcea. 
in  a  woman  of  22,  of  thirteen  months  standing.     The  atlas  was 
to  the  left;  the  posterior  cervical  tissues  were  all  thick  and  tense, 
especially  upon  the  left ;  the  seventh  dorsal  spine  was  rather  irreg- 
ular.    The  pelvis  was  twisted,  with  apparent  lengthening  of  the 
right    limb.     The  treatment  at  once  benefited  the  case,    and  it 
was  cured  in  4  months. 

(8)  A  case  of  paroxysmal  sleep,  or  narcolepsy,  presenting 
lesion  in  the  form  of  a  luxation  of  the  second  cervical  vertebra 
toward  the  right.     The  case  was  not  observed  under  treatment. 

(9)  A  case  of  narcolepsy  due  to  cervical  lesions  successfully 
treated. 

(10)  A  case  of  protracted  sleep,  in  which  the  patient  fell 
asleep  on  April  26,  1902,  and  slept  for  3  months,  with  but  few 
periods  of  awakening.     The  lesion  was  found  between  the  skull 
and  the  atlas,   causing,  probably,  passive  congestion.     Correc- 
tion of  the  lesion  cured  the  case,  after  all  other  means  had  failed. 

LESIONS  AND  ANATOMICAL  RELATIONS:     The  lesions,  both 
in  insomnia  and  in  the  various  other  disorders  of  sleep  are  gen- 


PRACTICE  OF  OSTEOPATHY.  295 

erally  found  in  the  atlas  and  cervical  and  upper  dorsal  regions. 
All  such  cases,  perhaps  constituting  a  majority  of  all  cases  of 
these  diseases,  should  be  regarded  from  the  osteopathic  point 
of  view  as  idiopathic  insomnia,  dependent  upon  specific  lesion 
interfering  with  circulation  to  the  brain.  Lesions  to  the  atlas 
and  second  cervical  vertebra  are  very  common  causes,  and  le- 
sions usually  occur  within  the  cervical  region  or  among  the  upper 
five  dorsal  vertebrae.  Lesions  to  clavicle  and  to  corresponding 
ribs  may  be  present.  It  will  be  observed  that  from  the  occiput 
to  5th  dorsal  all  these  lesions  fall  within  an  area  particularly  rich 
in  sympathetic  and  vaso-motor  centers  for  the  head,  as  before 
pointed  out.  Atlas  and  axis  lesion  acting  upon  the  superior 
cervical  ganglion,  medulla,  or  cervical  sympathetic,  and  other 
cervical  and  the  upper  dorsal  lesions  acting  upon  the  sympathetic 
nerves  supplying  vaso-motor  control  to  the  blood  vessels  of  neck 
and  head,  disturb  circulation  to  the  brain  and  cause  the  insomnia. . 
Direct  pressure  of  the  cervical  vertebrae  upon  the  vertebral  arteries 
may  contribute  to,  or  produce,  the  same  result. 

It  is  probable  that  in  many  cases  of  insomnia  there  is  an 
anemic  state  of  the  brain  caused  by  the  interference  of  such  le- 
sions with  the  sympathetics  or  by  direct  pressure  upon  the  arteries. 
The  insomnia  in  various  diseases  of  the  heart  and  arteries,  in 
general  anemia,  and  in  Bright's  disease,  is  said  to  be  due  to  an 
anemic  condition  of  the  brain.  On  the  other  hand  it  is  doubtless 
true  that  there  is  in  many  cases  a  sluggish  or  impeded  cerebral 
circulation  as  a  result  of  the  disturbance  of  sympathetic  vaso- 
motors,  impeded  venous  return,  etc.,  caused  by  these  lesions. 
In  neurasthenic  insomnia,  it  is  said,  there  is  loss  of  vaso-motor 
tone  in  the  cerebral  vessels.  The  use  of  various  mechanical  rem- 
edies is  based  upon  the  idea  of  calling  the  blood  from  the  head 
to  the  skin  or  abdominal  organs,  i.  -e.,  a  hot  foot-bath,  eating  a 
light  lunch,  etc. 

In  some  cases  the  symptoms  indicate  the  necessity  of  in- 
creasing or  decreasing  the  amount  of  blood  in  the  cerebral  ves- 
sels, and  these  results  may  be  readily  attained  by  the  appropriate 
treatment.  But,  from  the  nature  of  the  case,  removal  of  lesion 
and  the  restoration  of  free  circulation  result  in  restoring  normal 
quiet  to  the  nerve  mechanism  and  normal  flow  of  the  blood  in 


296  PRACTICE    OF    OSTEOPATHY. 

the  vessels,  characteristic  of  the  normal  body  which  enjoys  health- 
ful sleep.  Such  a  result  is  the  most  rational  object  of  the  treat- 
ment. 

When  insomnia  is  symptomatic  or  secondary,  lesions  must 
be  sought  according  to  the  primary  condition. 

In  some  cases  of  disturbed  vaso-motor  conditions  of  the 
brain,  lesion  is  found  in  the  form  of  much  thickened,  tensed,  and 
overgrown  tissues  at  the  base  of  the  skull,  above  and  about  the 
spine  of  the  axis,  extending  laterally  toward  the  mastoid  process. 
With  this  condition  there  frequently  exists  an  approximation  of 
the  second  cervical  spine  to  the  occiput. 

The  PROGNOSIS  in  insomnia  is  good.  No  class  of  cases  pre- 
sent more  striking  results  in  the  shape  of  cure  of  the  most  long- 
standing and  intractable  cases.  It  is  a  frequent  occurrence  that 
a  case  of  some  years  standing  is  made  to  sleep  naturally  after  a 
single  or  few  treatments. 

Not  all  cases  thus  easily  yield  to  treatment.  Often  great 
patience  and  persistence  are  necessary  to  secure  good  results. 

The  TREATMENT  calls  for  the  removal  of  lesion  primarily, 
and  of  any  cause  of  irritation  to  the  nervous  system.  The  treat- 
ment as  described  in  detail  for  headache,  q.  v.,  is  applicable  here. 
It  embraces  inhibition  of  the  superior  cervical  ganglion  and  of 
all  the  cervical  vaso-motors,  including  the  middle  and  inferior 
cervical  ganglia  and  the  upper  dorsal  centers,  deep  pressure  be- 
neath the  ears  and  beneath  the  occiput.  All  the  cervical  muscles 
and  other  tissues  should  be  thoroughly  relaxed.  A  general  spinal 
treatment,  in  nervous  cases,  at  once  relieves  nerve-tension  and 
irritation,  and  materially  aids  in  producing  sleep.  It  is  some- 
times well  to  add  to  this  a  general  body  treatment  as  an  aid  in 
equalizing  circulation  and  toning  up  the  nervous  system.  All 
points  of  cervical  circulation  should  be  attended  to.  The  treat- 
ment begun  over  forehead  and  face  may  be  continued  down  over 
the  neck,  opening  the  mouth  against  resistance,  stimulating  the 
carotid  arteries  and  jugular  veins,  raising  the  clavicles,  and  even 
the  upper  few  ribs,  and  thus  entirely  freeing  the  circulation  to 
and  from  the  head. 

In  cases  of  congestion  of  the  cerebral  vessels  the  inhibitive 


PRACTICE    OF    OSTEOPATHY.  297 

abdominal  treatment  should  be  used  to  draw  the  blood  away 
from  the  head  to  the  abdominal  vessels. 

In  anemic  cases  one  should  add  treatment  to  liver,  kidneys, 
stomach,  bowels  and  spleen.  The  heart  and  lungs  should  be 
stimulated.  In  insomnia  due  to  auto-intoxication,  as  in  lithemia, 
uremia,  malaria,  etc.,  one  should  look  particularly  to  the  excre- 
tions. Various  domestic  remedies  may  prove  useful  in  simple 
cases,  such  as  a  warm  general  bath,  a  hot  foot-bath,  a  cold  douche 
down  the  spine,  exercise  and  light  massage,  sleeping  in  cold  rooms, 
avoidance  of  late  meals,  and  the  avoidance  of  mental  work  sev- 
eral hours  before  retiring. 

The  various  perversions  of  sleep,  such  as  dreams,  and  night- 
mare, sommolentia,  or  incomplete  sleep,  somnambulism,  morbid 
drowsiness,  narcolepsy,  catalepsy  and  prolonged  sleep,  would 
all  be  approached  and  treated  upon  the  same  lines  as  laid  down 
for  insomnia. 

PARALYSIS. 

The  various  formes  of  paralysis  come,  with  much  frequency, 
under  osteopathic  treatment.  Paralysis  of  every  part  of  the  body 
and  from  various  causes,  is  successfully  treated.  The  following 
cases  are  illustrative. 

CASES:  (1)  Paraplegia  in  a  young  lady,  caused  by  a  fall 
of  eighteen  feet.  The  lower  half  of  the  body,  and  the  lower 
limbs  were  paralyzed;  control  of  the  bladder  was  lost;  within 
a  certain  period  of  five  months  she  had  passed  twenty-eight 
calculi  about  the  size  of  peas,  never  before  the  accident  having 
had  any  urinary  trouble.  Lesions  as  follows:  Marked  pos- 
terior and  slight  lateral  curvature  of  the  spine,  involving  the  lower 
and  upper  lumbar  regions.;  the  coccyx  was  bent  and  twisted;  the 
right  innominate  bone  was  luxated  backward.  The  condition 
was  of  nine  and  one-half  months  standing.  After  the  first  treat- 
ment she  was  able  to  sleep  without  the  customary  opiate.  During 
the  second  weeks  treatment  she  began  to  gain  control  of  the  blad- 
der, and  the  bowels  acted  naturally.  The  urine  became  normal 
at  this  time.  During  the  course  of  the  treatment  an  ulcer  upon 
the  right  foot  healed.  A  course  of  two  months  treatment  had 
almost  cured  the  patient  at  the  time  of  reporting  the  case. 


298  PRACTICE    OF    OSTEOPATHY. 

(2)  Paraplegia  in  a  man,  due  to  an  injury  in  a  runaway 
accident  in  which  he  was  thrown,  striking  the  lower  dorsal  and 
lumbar  regions  of  the  spine.     After  two  weeks  he  gradually  be- 
gan to  lose  the  use  of  his  limbs,  and  in  seven  months  he  was  con- 
fined to  a  chair,  soon  becoming  unable  to  move  a  muscle  of  either 
limb.     Lesions  were  as  follows:  9th,  10th  and  llth  dorsal  ver- 
tebrae backward  sufficiently  to  simulate  the  posterior  angular 
projection  in  Pott's  disease;  a  marked  contraction  of  the  mus- 
cles of  the  right  side  of  the  spine  to  the  same  side  as  the  contrac- 
ture  and  limited  by  its  extent;  great  tension  and  slight  lesion  at 
the  junction  of  the  fifth  lumbar  vertebra  with  the  sacrum ;  a  bind- 
ing together  of  all  the  spinal  vertebras  by  an  apparant  contrac- 
ture  of  the  ligaments.     After  a  fewr  treatments  motion  returned, 
and  the  patient  was  able  to  go  about  upon  crutches.     The  case 
had  been  almost  cured  after  a  course  of  five  weeks  treatment. 

(3)  Complete  paralysis  of  the  body  below  the  waist,  and  of 
the  lower  limbs,  caused  by  spinal  curvature.     The  case  was  en- 
tirely cured,  sensation,  motion,  and  function  of  abdominal  and 
pelvic  organs  being  restored. 

(4)  Lack  of  free  use  of  the  feet  due  to  a  paralytic  stroke  six 
years   before.     A   disarticulation   among   the   tarsal   bones   wras 
discovered,  and  its  removal  practically  cured  the  case. 

(5)  Paraplegia,  paitial,   was  cured  by  correction  of  lesion 
of  the  sixth  dorsal  vertebra. 

•  (6)  General  paralysis  in  a  case  which  gradually  for  six  years 
lost  the  use  of  all  the  voluntary  muscles,  the  eyes  were  crossed 
and  nearly  blind,  bowels  and  bladder  were  involved.  The  case 
was  cured  by  adjusting  lesion  between  the  atlas  and  occiput,  the 
latter  being  displaced  anteriorly  upon  the  former. 

(7)  Infantile  paralysis  involving  the  left  lower  limb.     The 
case  was  in  a  child  two  years  old.     A  sacro-iliac  lesion  was  found 
as  the  cause,  and  was  treated.     The  child  could  move  the  limb 
slightly  after  the  first  treatment,  and  after  the  sixth  treatment 
perfect  use  was  restored. 

(8)  A  case  of  paralysis  was  found  presenting  lesions  at  the 
occipito-atlantal  and  lumbo-sacral  articulations,   and  from  the 
sixth  to  the  tenth  dorsal  vertebrae.     There  was  a  history  of  ex- 
posure,   alcoholism,    sexual    excess    and    great    physical    strain. 


PRACTICE    OF    OSTEOPATHY.  299 

Correction  of  the  lesions  effected  a  cure  in  five  months. 

(9)  A  case  of  paraplegia  in  a  man  of  fifty-five,  due  to  injury 
in  a  railroad  wreck.     Both  innominate  bones  were  found  dis- 
placed anteriorly,  and  lesions  were  involving  the  whole  lumbar 
and  lower  dorsal  regions  of  the  spine.     The  paralysis  of  the  limbs 
was  total.     After  three  treatments  the  patient  could  walk  with 
crutches.     After  two  weeks  treatment  the  patient   could  walk 
without  crutch  or  cane,  being  as  well  as  ever,  excepting  some 
weakness  of  the  spine. 

(10)  Paraplegia,  involving  the  bowels,  in  a  lady  of  fifty- 
three,  and  of  fifteen  years  standing.     Sensation  was  lacking  in 
the  limbs,  and  there  was  very  little  motion.     In  less  than  one 
months   treatment   sensation   and    motion   were   both   perfectly 
restored,  and  the  bowels  were  acting  naturally. 

(11)  Paralysis    following    a    stroke.     The    cervical    muscles 
were   found   contractured.     Their   correction   was   accomplished 
in  five  weeks,  and  none  of  the  paralytic  condition  remained. 

(12)  Paralysis   affecting   the   fingers   and    thumbs   of   both 
hands  in  a  boy  of  fourteen     The  only  lesion  was  contracture 
of  the  muscles  along  the  lower  cervical  and  upper  dorsal  regions 
of  the  spine.     There  was  also  some  atrophy  of  the  muscles  over 
the  brachial  plexus  and  the  axillary  artery.     Five  months  treat- 
ment restored  the  thumbs  and  first  two  fingers  to  nearly  normal 
condition,  the  condition  of  the  other  fingers  was  much  improved, 
and  the  hands  could  be  used  considerably. 

(13)  Paralysis  and  muscular  atrophy  of  both  arms  in  a  boy 
six  years  of  age.     The  condition  followed  an  attack  of  malaria. 
The  condition  spread  to  involve  both  lower  limbs.     Spinal  le- 
sions were  found  preventing  circulation  to  the  cord.     The  child 
began  at  once  to  improve  under  the  treatment.  After  the  third  treat- 
ment he  could  move  his  fingers.     In  two  weeks  he  could  use  his 
hands  well  enough  to  feed  himself.     In  one  month  he  was  prac- 
tically cured. 

(14)  Disseminated   subacute   cervical   and  lumbar  myelitis 
in  a  boy  of  seven,  following  the  swallowing  of  two  pins.     Severe 
illness  at  once  followed,  and  in  the  fifth  week  the  pins  were  lo- 
cated by  the  X-ray  on  the  left  side  about  the  level  of  the  third 
cervical  vertebra.     They  were  later  ejected,  he  becoming  imme- 


300  PRACTICE    OF   OSTEOPATHY. 

diately  totally  paralyzed.  For  two  weeks  it  was  thought  he  could 
not  live.  After  about  seven  weeks  the  case  came  under  osteo- 
pathic  treatment.  The  tissues  of  the  entire  cervical  region  were 
badly  swollen  and  intensely  painful,  and  this  condition  was  found 
along  the  whole  spine.  Control  of  the  bowels  and  bladder  was 
lost,  and  the  muscles  of  both  upper  and  lower  limbs  were  atrophied. 
After  the  first  treatment  the  patient  slep  soundly  for  the  first 
time  in  two  weeks.  After  about  four  months  treatment  the  case 
was  practically  cured. 

(15)  Monoplegia  attacking  the  right  lower  limb  of  a  girl 
of  six,  paralyzed  since  the  age  of  ten  as  the  result  of  spinal  men- 
ingitis.    No  bony  lesion  was  found,  but  the  treatment    was  di- 
rected to  increasing  the  circulation  to  the  cord.     The  case  was 
practically  cured  in  three  months  treatment. 

(16)  Paraplegia    of    eight    months    standing.     The    patient 
was  bedridden.     Lesion  was  found  as  a  posterior  condition  of 
all  the  lumbar  vertebrae  and  a  slip  of  the  last  lumbar  upon  the 
sacrum.     The  case  was  cured  in  three  months. 

(17)  Bell's  disease   (facial  paralysis),  due  to  lesion  at  the 
second  cervical  vertebra,  cured  in  three  weeks. 

(18)  Partial  paralysis  of  the  lower  limbs,   of  four  months 
standing,  due  to  lesions  at  the  sacro-iliac  articulation  and  at  the 
5th  dorsal  vertebra,  cured  in  two  months. 

(19)  Partial  paralysis  in  a  lower  limb  in  a  girl  of  six,  since 
infancy,  accompanied  by  under-development  of  the  limb,  was 
found  to  be  due  to  a  partial  dislocation  of  the  hip,  and  was  cured 
in  two  months. 

(20)  Paralysis,  probably  Progressive  Spinal  Muscular  Atro- 
phy, in  a  woman  of  thirty-five,  of  fifteen  years  standing.     The 
last  two  years  had  been  spent  in  bed.     Lesions  were  found  at 
the  7th  cervical  and  1st  dorsal  vertebrae,  which  were  anterior. 
The  case  was  cured  in  ten  months. 

(21)  Paralysis   of  the  fingers,  affecting  the    last    two,  and 
partly  the  middle  finger  of  the  right  hand.     The  patient  was  a 
lady  of  seventy-nine  years  of  age.     A  fall  upon  the  hand  had 
occurred  a  short  time  previously.     A  slight  lateral  lesion  of  the 
first  dorsal  vertebra  was  found  and  corrected,  curing  the  case 
in  six  weeks. 


PRACTICE    OF   OSTEOPATHY.  301 

(22)  Hemiparesis  or  Hemiplegia  in  a  lady  of  sixty,  of  six 
weeks  standing.     The  right  side  was  affected.     Lesion  was  found 
in  the  3rd  cervical  and  5th  lumbar  vertebrae,  the  spinal  muscles 
also  being  much  contracted.     The  patient  walked  after  the  third 
treatment  and  was  cured  in  six  weeks. 

(23)  Hemiplegia,  partial,  of  the  right  side,  following  light- 
ning-stroke.    A  displacement  of  the  atlas  was  found  and  righted 
at  once,  immediately  curing  the  case. 

(24)  Paralysis  and  Dysentery.     The  paralysis  affected  the 
lower  limbs,  and  had  been  of  seven  years  standing.     Lesion  was 
found  as  great  tenderness  at  the  lumbo-sacral  joint,  a  slip  for- 
ward of  the  5th  lumbar,  luxation  of  the  innominates,  and  a  lateral 
swerve  of  the  lumbar  and  lower  dorsal  region  of  the  spine.     A 
tremor  of  the  head  was  present,  the  cervical  muscles  being  very 
tense.     After  seven  months  treatment  the  lesions  were  about 
overcome  and  the  patient  was  nearly  well. 

(25)  Paralysis  affecting  certain  muscles  of  the  throat,  also 
affecting  the  speech.     The  lesion  was  found  in  a   contracture 
holding  the  hyoid  bone  out  of  place.     The  patient  was  cured  by 
relaxing  the  contracture. 

(26)  Facial  paralysis  of  more  than  one  year  standing,  was 
cured  in  three  weeks  treatment.     The  lesion  was  found  in  a  dis- 
placement of  the  second  cervi-cal  vertebra. 

(27)  Facial  paralysis  caused  by  luxation  of  the  atlas  and 
axis  to  the  left.     There  was  also  tension  of  the  tissues  at  the 
base  of  the  skull  and  on  the  left  side  of  the  neck.     The  case,  still 
under  treatment,  was  improving  satisfactorily. 

(28)  Facial  paralysis  was  seen  on  the  day  following  its  first 
appearance.     The  lesion   was  marked   muscular  contraction  at 
the  angle  of  the  jaw  on  the  affected  side.     Treatment  gave  im- 
mediate relief,  and  the  case  had  almost  been  cured  in  "ten  treat- 
ments. 

(29)  Progressive  paralysis  in  a  case,  after  two'  falls  causing 
serious  illness.     Motion  in  the  lower  limbs  was  lost,  blindness 
ensued,  and  speech  became  unintelligible.     There  was  formication 
in  the  hands  and  arms,and  extreme  pain  along  the  spine,occurring 
in  agonizing  paroxysms.     Lesions  were  found  as  a  lateral  dis- 
location of  the  third  cervical  vertebra,  luxation  of  7th  and  8th 


302  PRACTICE  OF  OSTEOPATHY. 

right  ribs,  and  a  posterior  protrusion  of  the  lumbar  vertebrae. 
One  treatment  brought  the  first  sleep  possible  in  three  days. 
Under  treatment  the  spinal  pain  was  relieved,  vision  was  restored, 
and  the  patient  had  been  practically  cured  at  the  time  of  the  report. 

(30)  Crutch  paralysis  in  a  man  of  sixty-five,  causing  loss  of 
use  of  the  left  hand.     A  crutch  had  been  used  on  the  left  side. 
The  head  of  the  second  left  rib  was  found  displaced,  and  the  head 
of  the  humerus  was  slightly  dislocated  anteriorly.     After  eleven 
treatments  the  patient  was  well. 

(31)  Myotonia   Congenita    (Thomsen's   Disease)    in   a   man, 
of  ten  years  standing.     Lesion  of  spinal  vertebrae  was  removed, 
curing  the  case. 

(32)  Hemiplegia  in  a  child  twenty  months  old,  of  ten  months 
standing.     Lesion  was  found  at  the  atlas,  which  was  immediately 
replaced,  and  rapid  improvement  followed.     In  three  weeks  the 
child  could  walk,  and  recovery  was  almost  perfect. 

(33)  Brachial    Neuritis    of    five    months    standing,    causing 
severe  pain  in  arms  and  shoulders,  and  partial  paralysis  of  the 
hands.     Lesions  were  found  in  luxation  of  the  2nd,  3rd  and4th 
right  ribs,  and  the  2nd  left  rib,  with  irregularities  of  the  lower 
cervical    and    upper   dorsal    vertebrae.     One    treatment    greatly 
relieved  the  pain;  three  treatments  enabled  the  patient  to  close 
his  hands  and  snap  his  fingers;  and  in  three  months  treatment 
the  case  was  entirely  cured. 

(34)  Partial  paralysis  of  one  hand,   loss  of  memory,   and 
at  times  inability  to  articulate.     Lesion  was  found  at  the  2nd 
cervical  vertebra.     The  case  was  cured  by  one  months  treat- 
ment. 

LESIONS:  The  facts  of  these  cases  are  typical,  and  illustrate 
much  that  is  seen  in  the  practice  upon  this  class  of  cases.  They 
point  prominently  to  importance  of  anatomical  lesion  of  the 
kind  most  regarded  by  osteopathy,  as  the  cause  of  paralytic  dis- 
eases. The  necessity  of  the  removal  of  such  lesion  in  curing  the 
condition  is  obvious.  These  facts  clearly  indicate  the  great  po- 
tency of  actual  bony  lesion,  derangement  of  a  bony  part,  in  caus- 
ing paralysis.  They  illustrate  also  what  experience  shows  to 
be  a  fact,  that  displacement  of  spinal  vertebrae  occurs  as  the 
real  cause  of  a  majority  of  the  cases  of  paralysis.  Rib  lesions 


PRACTICE    OF   OSTEOPATHY.  303 

sometimes  occur,  but  do  not  seem  to  be  important  as  causes  of 
such  disease.  The  finding  of  a  partial  dislocation  of  a  hip  as  the 
cause  of  paralysis  in  a  limb  is  a  fine  point  of  osteopathic  diagnosis. 
These  lesions  are  occasionally  found  and  are  of  prime  importance. 
They  are  almost  invariably  overlooked  in  the  usual  line  of  prac- 
tice. Their  reduction  is  the  sole  and  immediate  remedy  of  the 
monoplegia.  In  a  few  cases  both  hips  have  been  found  thus 
luxated  causing  apparent  paraplegia. 

Contractured  muscles  are  no  doubt  generally  secondary 
lesions.  But  with  some  frequency  they  have  been  found  as  the 
sole  discoverable  cause  of  paralysis,  and  their  removal  has  re- 
sulted in  cure. 

Innominate  lesion  is  found  to  be  of  the  greatest  importance 
in  causing  paralysis  of  the  lower  extremities.  The  coccyx  le- 
sion does  not  seem  to  be  important  in  this  connection.  The  atlas 
lesion  is  perhaps  the  most  important  single  lesion,  notwithstand- 
ing the  fact  that  it  does  not  with  great  frequency  occur  as  the 
sole  cause  of  a  paralytic  condition.  Occurring  at  a  part  of  the 
spine  where  the  bones  are  small  and  the  contained  portion  of  the 
cord  large,  it  is  particularly  likely  to  impinge  upon  the  medulla 
and  cause  paralytic  effects  in  the  whole  body  below,  upon  one  side 
of  the  body,  or  in  the  head  and  its  parts.  As  shown  above,  le- 
sions of  the  atlas  occurred  in  five  of  these  cases.  It  was  present 
in  two  of  these  cases  suffering  paralysis  of  both  upper  and  lower 
limbs.  In  one  of  these  cases,  in  which  also  there  was  blindness 
and  crossing  of  the  eyes,  it  was  the  sole  lesion.  This  circum- 
stance is  well  illustrative  of  the  importance  of  the  atlas  lesion. 
In  two  cases  it  was  the  sole  lesion  causing  hemiplegia.  It  was 
present  with  lesion  of  the  axis  in  a  case  of  facial  paralysis. 

A  glance  at  the  summary  of  the  lesions  will  show  the  very 
general  range  of  these  bony  lesions.  Atlas,  axis,  cervical,upper 
dorsal,  middle  dorsal,  lower  dorsal,  lumbar,  innominate,  coccyx, 
hip,  rib  and  shoulder  lesions'  were  found.  It  seems  that  any 
movable  part  along  the  spine,  or  in  relation  with  the  various  nerve- 
plexuses  concerned  in  the  various  paralysis,  may  become  mis- 
placed and  become  a  factor  in  producing  a  paralytic  condition. 
Yet  there  is  a  great  deal  of  constancy  of  lesion.  It  tends  as  much 
toward  the  specific  in  this  class  of  cases  as  in  any.  Generally 


304  PRACTICE    OF   OSTEOPATHY. 

in  paraplegia,  monoplegia  or  paralysis  of  the  two  upper  limbs 
the  lesion  is  local  at  a  place  where  it  may  affect  the  origin  of  the 
nerves  concerned  in  the  innervation  of 'the  parts  involved.  All 
of  these  seven  cases  of  paraplegia  show  this  in  low  lesion  along 
the  spine.  All  the  six  cases  of  monoplegia  show  it  in  local  le- 
sions to  the  origin  of  the  plexuses  involved. 

It  often  happens  that  in  cases  of  paralysis  involving  the 
upper  and  lower  limbs,  one  or  both,  there  is  a  high  lesion  affect- 
ing the  upper  and  a  low  lesion  affecting  the  lower  members.  Yet 
a  single  lesion  high  up  more  frequently  perhaps  causes  the  trouble 
in  the  upper  and  lower  limbs.  Lesions  of  the  fifth  lumbar  and  of 
the  innominates  are  frequent  in  paralysis  and  in  hemiparaplegias. 
These  are  important  lesions. 

An  inspection  of  the  lesions  reported  in  seven  of  the  above 
paraplegia  cases  show  that  the  lower  dorsal  and  upper  lumbar 
region  is  a  favorite  place  for  lesions  in  such  cases;  that  spinal 
curvatures  may  cause  the  condition;  that  fifth  lumbar  and  in- 
nominate lesions  are  much  in  evidence. 

In  case  of  general  paralysis  involving  upper  and  lower  limbs 
it  is  noted  that  atlas1  lesion  alone  may  be  the  cause;  that  often 
there  are  both  upper  and  lower  lesions,  respectively  affecting 
upper  and  lower  limbs;  and  t-hat  contractured  muscles  and  causes 
obstructing  circulation  to  the  cord  may  be  sufficient. 

The  monoplegias  show  much  constancy  of  lesion  to  the 
origin  of  the  plexuses.  The  hip-joint,  shoulder-joint,  and  sacro- 
iliac  lesion  all  attract  attention.  The  hemiplegias  seem  more 
apt  to  show  single  high  lesion,  as  of  the  atlas,  but  both  high  and 
low  spinal  lesions  may  be  present.  Dr.  Still  says  that  in  hem- 
iplegia  the  atlas  is  often  back  and  to  the  left. 

The  facial  paralysis  shows  specific  bony  lesions.  In  three 
of  the  four  cases  the  2nd  cervical  vertebra  is  involved.  In  one 
of  these  three  the  atlas  is  also  at  fault.  In  a  fourth  case  there 
was  merely  contracture  of  muscles  occurring  over  the  course  of 
the  trunk  of  the  nerve  where  it  crosses  the  ramus  of  the  jaw.  In 
these  cases,  bony  lesions  if  present,  are  expected  to  occur  among 
the  upper  three  cervical  vertebrae. 

ANATOMICAL  RELATION'S:  The  close  relation  between  the 
esion  and  the  disease  is  shown  by  several  facts.  The  early  de- 


PRACTICE  OF  OSTEOPATHY.  305 

velopment  of  paralysis  after  accident  giving  origin  to  those  le- 
sions found  upon  examination  to  exist  at  important  points  in- 
dicates the  correctness  of  the  osteopathic  idea  that  such  lesions 
are  the  direct  causes.  The  further  fact  that  recovery  is  depend- 
ent upon  the  removal  of-  such  lesions,  that  it  actually  is  accom- 
plished by  their  removal,  also  shows  the  close  relation  of  lesion 
to  paralytic  disease.  Finally  the  Osteopath's  experience  directs 
him  to  expect  bony  lesion  at  certain  spinal  areas,  according  to 
nerve-distribution  from  the  spine  to  affected  parts.  In  all  these 
cases  we  speak  of  lesion  significant  to  the  Osteopath  only. 

The  various  lesions,  bony  and  otherwise,  act  in  several  ways 
to  cause  the  paralytic  effect  that  follows  their  presence.  In  the 
first  place,  a  misplaced  vertebra  or  bony  part,  or  a  contractured 
muscle,  may  brine  direct  pressure  upon  a  nerve,  a  fibre,  or  a  plexus, 
cutting  off  its  function  and  causing  paralysis  in  its  area  of  dis- 
tribution. In  one  case  pressure  of  the  first  dorsal  vertebra  upon 
the  last  cervical  and  first  dorsal  nerves,  one  or  both,  which  make 
up  the  ulnar  nerve,  resulted  in  paralysis  in  the  ulnar  distribution 
in  the  hand,  affecting  the  little  finger,  ring-finger,  and  in  part 
the  middle  finger.  The  same  conclusion  is  indicated  in  the  case 
in  which  contracture  of  the  hyoid  muscles  drew  the  bone  against 
the  pneumogastric  nerve,  causing  paralysis  of  the  laryngeal 
muscles,  affecting  deglutition  and  speech.  The  same  evidence 
of  direct  pressure  upon  nerves  is  seen  in  another  case  where  the 
muscles  contracted  over  the  trunk  of  the  facial  nerve;  in  another 
where  the  head  of  the  humerus  impinged  the  brachial  plexus;  in 
another  where  the  sacro-iliac  lesion  affected  the  sacral  nerves. 
In  all  of  these  cases  quick  results  following  the  removal  of  pressure 
show  that  the  effect  of  the  lesion  must  have  been  directly  upon 
the  nerves  involved  by  pressure. 

In  such  cases  the  result  is  seen  to  be  directly  upon  the  pan 
supplied  by  the  impinged  nerves,  it  is  uncomplicated  by  results 
in  other  parts  of  the  body,  and  is  manifested  in  a  circumscribed 
area,  namely,  in  the  muscle  groups  supplied  by  the  nerve  or 
nerves  in  question.  In  diagnosis  a  practical  point  is  to  expect 
lesion  of  a  kind  exerting  direct  pressure  in  case  presenting  gen- 
eral features  as  described  above.  The  lesion  is  known  at  once 

20 


306  PRACTICE    OF   OSTEOPATHY. 

to  be  located  some  where  in  the  path  or  at  the  origin  of  the  nerves 
involved. 

On  the  other  hand,  a  certain  class  of  lesion  is  found  in  par- 
alytic disease  by  lesion  to  the  cord.  The  effect  to  the  cord  may 
be  through  direct  pressure  upon  it,  or  in-  other  ways.  An  example 
of  such  conditions  is  seen  in  a  case  in  which  lesion  of  the  2nd  cer- 
vical vertebra  caused  partial  paralysis  in  one  hand,  loss  of  mem- 
ory, and  at  times  inability  to  articulate.  There  was  evident 
involvement  of  brain  and  cord,  and  the  lesion  was  too  high  to 
affect  the  brachial  plexus  by  direct  pressure.  In  such  case  there 
is  possibility  of  the  lesion  affecting  the  cord  either  by  direct 
pressure  or  by  interference  with  the  sympathetic  or  cord-nutri- 
tion. The  supposition  of  direct  pressure  is  supported  by  the 
fact  that  removal  of  the  lesion  cured  the  case  in  one  month. 
In  another  case,  formication  in  the  upper  and  paralysis  in  the 
lower  limbs,  blindness,  unintelligible  speech,  and  paroxysms  of 
spinal  pain,  clearly  indicate  involvement  of  cord  and  brain. 
The  lesion  of  the  3rd  cervical  vertebra  was  too  high  to  affect  the 
brachial  plexus  by  direct  pressure;  the  lesion  to  the  lumbar  ver- 
tebra likewise  could  not  have  pressed  directly  upon  the  nerve- 
supply  to  the  lower  limbs.  Yet  the  paralytic  condition  in  lower 
limbs,  referable  to  the  posterior  displacement  or  protrusion  of  the 
lumbar  vertebrge,  favors  the  theory  of  direct  pressure  upon  the 
cord,  since  such  paralysis  of  the  lower  limbs  is  known  to  follow 
actual  lesion  to  the  lumbar  segments  of  the  spinal  cord. 

In  one  case  the  hemiplegia  resulted  from  lesion  at  the  atlas, 
and  was  cured  by  its  removal.  The  fact  that  the  child  could 
walk  in  three  weeks  after  treatment  began,  and  the  highness  of 
the  lesion,  both  favor  the  idea  that  there  was  pressure  upon  the 
cord.  In  a  case  where  there  was  paralysis  of  the  voluntary  mus- 
cles, crossed  eyes,  and  partial  blindness,  the  lesion  was  again  at 
the  atlas  (occipito-atlantal)  and  the  same  reasoning  would  ap- 
ply. So  in  another  case,  paraplegia  following  lesion  of  the  6th 
vertebra. 

It  must  be  noted  that  in  all  these  cases  the  results  are  quite 
unlike  those  in  the  first  group  considered.  The  results,  instead 
of  being  direct  upon  nerve  or  plexus,  are  indirect;  they  are  also 
complicated  with  effects  in  more  than  one  part  of  the  body,  and 


PRACTICE    OF    OSTEOPATHY.  307 

are  not  circumscribed  by  being  limited  to  one  muscle  group. 
It  is  an  indication  in  diagnosis  to  expect  such  cord  lesions  in  cases 
showing  this  style  of  effects  from  lesion. 

In  some  cases  the  lesions  no  doubt  do  shut  off  nutrition  to 
the  cord  or  brain.  It  is  seen  in  cases  where  cervical  bony  lesion 
results  in  atrophy  of  the  optic  nerve,  causing  blindness  through 
interference  with  its  nutrition.  In  another  case  lesions  were 
described  as  being  present  and  preventing  circulation  to  the  cord. 
Treatment  with  the  idea  of  restoring  this  circulation  resulted  in 
quick  benefit  and  cure.  In  another  case,  the  lasting  effects  of 
the  meningitis  upon  the  cord  were  overcome  by  building  up  cir- 
culation to  it. 

Quickness  of  results  in  many  cases  indicates  functional 
derangement  from  pressure  of  the  lesion,  which  being  removed 
leads  to  immediate  restoration  of  function.  On  the  other  hand 
a  course  of  treatment  must  look  to  regeneration  of  nerves  and  of 
ganglion  cells  in  many  cases  where  degeneration  has  taken  place 
in  these  tissues  because  of  the  effect  of  the  lesion. 

In  hip  cases,  the  under-development  accompanying  the 
paralysis  is  often  due  to  pressure  upon  blood-vessels  as  well  as 
upon  nerves.  The  pressure  is  from  the  displaced  bone  and  the 
contractures  of  tissues. 

There  is  a  class  of  cases  of  paralysis  in  which  fever  has  been 
the  antecedent  factor,  as  in  cases  in  which  paralysis  of  a  limb 
follows  typhoid  fever.  The  paralysis  of  the  vocal-cords,  for  ex- 
ample, following  diphtheria,  is  often  seen.  Other  diseases, 
febrile  or  not  in  character,  in  which  there  is  much  auto-intoxica- 
tion, may  be  followed  by  similar  sequelae. 

In  these  cases,  the  poison  generated  in  the  system  affects 
nerve-centers,  or  nerves  direct,  producing  the  paralysis.-  Such 
sequelae  are  much  more  likely  to  occur  in  cases  in  which  strong 
medication  has  been  a  feature  of  the  treatment,  since  the  emunc- 
tories,  already  occupied  with  all  the  poison  they  can  eliminate, 
are  called  upon  to  handle  in  addition  that  introduced  into  the 
system  in  the  form  of  drugs. 

Such  sequelae  are  not  so  likely  to  occur  in  cases  treated  by 
osteopathic  therapeutics. 

In  the  cases  in  which  such  sequelae  occur,  the  locus  of  the 


308  PRACTICE  OF  OSTEOPATHY. 

paralysis  is  probably  determined  by  lesions  which  are  present  and 
affecting  certain  centers  or  nerves,  laying  them  liable  to  such 
effects  of  autointoxication.  It  is  evident,  also,  that  in  cases  in 
which  certain  of  the  emunctories  are  weakened  by  lesion,  such 
lesion  may  become  responsible  for  the  sequelae  through  having 
lessened  the  function  of  these  eliminative  organs. 

This  class  of  cases  is  well  handled,  usually,  if  not  of  too  long 
standing. 

The  PROGNOSIS  in  paralytic  cases  is  very  favorable.  A 
large  percentage  of  the  cases  is  entirely  cured.  Few  cases  are 
neither  benefited  nor  cured.  The  apparent  greatness  of  the 
lesion  bears  no  proportionate  relation  to  the  degree  of  the  effect. 
A  small  or  very  limited  lesion  often  causes  the  most  serious  par- 
alysis. 

Many  cases  are  slow  and  difficult.     Some  cannot  be  cured. 

The  length  of  standing  of  the  case  should  not  determine 
the  prognosis.  Recent  cases  may  be  the  most  difficult  to  cure. 
Many  of  the  most  long  standing  and  worst  cas2s  aro  quickly  ben- 
efited and  cured.  The  prognosis  is  good,  even  after  "strokes," 
and  often  where  there  is  blood-clot  on  thj  brain. 

TREATMENT:  The  bony  lesion  must  ba  1*3 moved.  This 
is  often  the  most  necessary  treatment.  But  most  cases  require 
a  course  of  treatment  to  regenerate,  through  the  blood-supply, 
the  nerves  and  centers  effected.  This  necessitates  insuring  a 
good  quality  of  blood,  and  in  many  such  cases  the  important 
first  step  consists  in  sufficient  treatment  to  bowels,  stomach, 
liver  and  kidneys  to  improve  the  general  health  and  expel  all 
impurities  from  the  blood. 

The  general  spinal  and  cervical  treatment  should  be  ap- 
plied to  tone  the  general  nervous  system  and  to  increase  the 
circulation  and  nutrition  of  it.  This  is  accomplished  by  relax- 
ation of  all  the  spinal  tissues,  separation  of  the  spinal  vertebra? 
to  allow  free  circulation,  and  stimulation  of  the  central  distribu- 
tion of  the  sympathetic  having  control  of  circulation  to  the  spine. 

In  case  of  blood-clot  upon  the  brain  the  treatment  is  to 
increase  cervical  circulation  to  absorb  it.  This  can  be  accom- 
plished in  cases  where  the  clot  has  not  had  time  to  become  or- 
ganized or  encysted.  After  cerebral  hemorrhage,  treatment 


PRACTICE  OF  OSTEOPATHY.  309 

should  keep  this  object  constantly  in  mind.  But  in  many  old 
cases  of  hemiplegia  after  cerebral  apoplexy,  where  doubtless  the 
clot  has  become  organized,  much  benefit  can  be  given  by  the 
treatment. 

Local  treatment  is  made  upon  the  paralyzed  limb  or  part 
to  soften  contractures,  build  up  circulation,  increase  nutrition 
of  the  tissues,  and  to  tone  the  local  nerve-mechanism. 

Lesions  as  described  in  this  chapter  will  be  found  in  most 
of  the  various  diseases  of  brain  and  spinal  cord.  The  same  prin- 
ciples and  methods  of  treatment,  varied  to  suit  the  case,  may  be 
applied  to  them. 

For  example,  in  CEREBRAL  HEMORRHAGE,  OR  CEREBRAL 
APOPLEXY,  strong  inhibition  is  made  at  once  upon  the  sub-oc- 
cipital regions  to  dilate  the  blood-vessels  and  to  aid  in  reducing 
the  congestion.  This  object  is  aided  in  a  most  important  manner 
by  the  general  cervical,  spinal  and  abdominal  treatment,  re- 
laxing all  tissues  and  calling  the  blood  to  these  parts  away  from 
the  head.  These  treatments  should  be  relaxing  and  inhibitive 
in  nature  as  before  described.  The  head  should  be  kept  raised 
to  aid  in  drawing  the  blood  from  it.  In  the  intervals  in  treat- 
ment the  ice-bag  may  be  applied  to  the  spine.  The  patient  should 
remain  quietly  in  bed  and  be  fed  upon  a  liquid  diet. 

After  the  acute  stage  the  treatment  should  be  carried  on 
to  remove  the  blood-clot  from  the  brain  and  to  overcome  the 
hemiplegia.  The  former  is  accomplished  by  the  usual  cervical 
treatments  to  increase  circulation  to  the  brain;  the  latter  by 
such  treatments  as  described  in  detail  above  for  cases  of  paralysis. 
The  clot  may,  if  taken  in  time,  be  completely  removed,  and  the 
patient  should  be  treated  twice  or  several  times  daily.  Later 
he  may  be  treated  daily  or  three  times  a  week. 

INFANTILE  PARALYSIS,  in  children  up  to  three  or  four  years 
of  age,  is  often  caused  by  disorders  of  the  digestive  tract,  as  in 
teething  or  after  catching  cold  or  in  bowel  complaint.  In  such 
cases  cerebral  congestion  and  spasms  are  prone  to  occur,  and 
during  the  spasm  a  vessel  is  burst  in  the  brain,  with  resulting 
hemorrhage  and  clot. 

In  some  of  these  cases  the  congestion,  hemorrhage,  clot,  and 
inflammation  occur  in  the  cord,  causing  ACUTE  ANTERIOR  POLIO- 


310  PRACTICE    OF    OSTEOPATHY. 

MYELITIS.  Such  cases  do  well  under  treatment  in  these  acute 
conditions,  and  the  resulting  Infantile  Paralysis,  if  seen  early, 
or  if  not  of  long  standing,  will  often  yield  well  to  a  persistent 
course. 

In  cases  of  HEMORRHAGE  INTO  THE  .SPINAL  MEMBRANES, 
HEMORRHAGE  INTO  THE  SPINAL  CORD,  and  HEMORRHAGE  INTO 
THE  MEDULLA  and  PONS  the  treatment  is  upon  quite  the  same 
lines  as  for  cerebral  hemorrhage.  In  the  first  two  conditions 
the  patient  should  be  kept  lying  upon  his  side  or  face,  not  upon 
his  back,  to  favor  the  drainage  of  the  blood. 

In  the  various  forms  of  SPINAL  MENINGITIS,  often  met  in 
our  practice,  good  prognosis  is  the  rule.  Cases  are  made  to  re- 
cover entirely,  all  paralysis  or  lingering  stiffness  of  the  muscles 
being  overcome.  The  treatment  in  the  acute  form  is  the  general 
spinal,  cervical,  and  abdominal,  to  control  the  circulation  of  the 
cord  and  call  the  blood  away  from  it.  The  rigidity  of  the  muscles 
is  overcome  by  manipulation  and  by  careful,  inhibitive  spinal 
treatment.  Bowels  and  kidneys  must  be  kept  active  by  treat- 
ment, to  aid  in  removing  toxic  products  from  the  system.  It 
may  be  necessary  to  use  a  catheter  on  account  of  the  paralysis 
of  the  sphincter  of  the  bladder.  In  the  intervals  of  treatment 
ice-bags  may  be  applied  along  the  spine.  A  course  of  treatment 
should  be  carried  on  to  insure  complete  resorption  of  the  in- 
flammatory products  from  about  the  cord,  and  to  prevent  or 
overcome  any  paralytic  sequel  to  the  condition. 

The  same  plan  of  treatment  will  apply  to  CHRONIC  SPINAL 
MENINGITIS,  and  to  the  various  forms  of  PACHYMENINGITIS  and 
LEPTOMENGITIS.  Further  special  treatment  is  to  be  applied 
according  to  the  needs  of  the  individual  case,  and  according  to 
the  manifestations  of  the  disease. 

In  MYELITIS  the  same  general  plan  of  treatment  should  be 
adopted  to  gain  vaso-motor  control  and  lessen  the  inflamma- 
tory process  in  the  cord.  Diagnosis  should  be  made  of  the  por- 
tions of  the  cord  affected,  and  treatment  should  be  applied  here 
particularly  to  absorb  the  extra vasted  blood  and  do  away  with 
the  danger  of  softening  or  degeneration  of  the  cord  following. 
The  patient  should  be  kept  quiet,  and  attention  be  given  to  any 
special  manifestation  in  the  case  requiring  alleviation.  Care 


PRACTICE    OF    OSTEOPATHY.  311 

must  be  taken  in  the  manipulation  to  avoid  all  irritation  of  the 
skin  on  account  of  the  liability  to  bed-sores.  Rigidity  and  spasm 
in  the  affected  muscles  may  be  overcome  by  inhibitive  manipu- 
lation of  them,  and  by  inhibition  of  the  nerves.  Guard  against 
renal  and  pulmonary  complications  by  keeping  the  lungs  and 
kidneys  well  stimulated.  A  course  of  treatment  must  follow  to 
guard  against  or  overcome  paralysis.  The  prognosis  is  good  in 
the  acute  case.  A  chronic  case  may  be  cured,  or  much  may  be 
done  for  its  benefit. 

In  CHRONIC  MYELITIS,  DISSEMINATED  MYELITIS,  and  ACUTE 
ANTERIOR  POLIO-MYELITIS,  (see  above)  the  same  line  of  treat- 
ment is  to  be  followed,  with  attention  to  special  manifestations  of 
the  disease  in  each  case. 

In  meningitis,  myelitis,  apoplexy,  etc.,  various  spinal  and 
cervical  lesions  occur,  of  the  kinds  pointed  out  in  the  general 
consideration  of  the  subject  of  paralysis. 

ACUTE  ASCENDING  PARALYSIS,  or  Landry's  Paralysis  should 
be  treated  according  to  the  directions  given  for  the  general  treat- 
ment of  paralysis.  The  spinal  treatment  must  be  particularly 
thorough,  and  heart  and  lungs  should  be  kept  well  stimulated. 
The  practitioner  must  be  constantly  upon  his  guard,  as  the  dis- 
ease runs  a  very  quick  course,  and  may  soon  terminate  in  death. 

SYRINGOMYELIA  should  be  treated  as  the  ordinary  case  of 
chronic  paralysis. 

PROGRESSIVE  BULBAR  PARALYSIS,  or  Labioglossopharyn- 
geal  paralysis,  needs  treatment  mostly  in  the  cervical  and  upper 
dorsal  regions,  in  order  to  remove  lesion  and  to  stimulate  the 
circulation  to  the  brain  to  prevent  the  atrophy  of  the  roots  of  the 
various  cranial  nerves  involved  in  the  condition.  The  general 
health  should  be  attended  to.  The  treatment  should^  include 
thorough  spinal  work  as  the  cord  tends  to  be  involved,  and  pro- 
gressive muscular  atrophy  may  appear. 

CEREBRAL   ANEURYSMS   are   to   be   treated    as   are   other 
aneurysms,  q.  v. 

HYDROCEPHALUS  calls  for  treatment  to  maintain  the  gen- 
eral health,  and  for  cervical  and  spinal  treatment  to  correct  cir- 
culation to  and  from  the  brain. 


312  PRACTICE   OF    OSTEOPATHY. 

CEREBRAL  PALSIES  OF  CHILDHOOD. 

(Infantile  Paralysis.) 

Under  this  head  are  included  hemiplegia,  the  birth  palsies, 
and  paraplegia.  The  various  forms  of  infantile  paralysis  (see 
above)  come  frequently  under  osteopathic  treatment.  Ordi- 
narily good  success  is  had  in  curing  them,  or  in  materially  bene- 
fiting conditions.  Many  require  a  long  and  patient  course  of 
treatment.  Some  are  soon  cured.  In  the  paraplegias  much 
is  done  to  help  out  the  retarded  downward  development  of  the 
motor  pathway.  It  is  upon  account  of  the  necessity  of  develop- 
ing this  part  of  the  cord  that  so  many  of  these  paraplegic  cases 
are  slow  to  be  cured,  yet  these  cases  have  often  been  cured.  In 
a  few  such  cases  slight  luxations  or  dislocations  of  the  hip- joint 
have  been  found  as  the  cause  of  the  condition. 

In  the  majority  of  these  cases  of  infantile  paralysis,  lesions 
of  the  cervical  vertebrae,  especially  of  atlas,  axis,  and  upper  ver- 
tebrae, is  found.  It"  is  doubtless  due  to  difficult  labor,  the  use 
of  forceps,  or  rough  handling  in  delivery.  Some  cases  are  doubt- 
less due  to  menigeal  hemorrhage  resulting  from  such  causes. 
Lesion  may  be  present  in  the  upper  dorsal  spine, 

The  TREATMENT  is  practically  that  described  for  the  gen- 
eral case  of  paralysis.  Correction  of  lesion  is,  of  course,  the 
indispensable  part  of  the  treatment.  Its  removal  frequently 
at  once  results  in  cure,  with  but  little  additional  treatment. 
The  thorough  general  spinal  and  abdominal  etc.,  treatment 
described  for  paralysis,  q.  v.,  should  be  applied  to  these  cases. 
A  long  course  of  such  treatment  is  the  rule.  The  cervical  treat- 
ment, and  the  treatment  usually  given  to  increase  cerebral  cir- 
culation should  be  given,  both  for  the  purpose  of  absorbing  a 
possible  clot  upon  the  brain,  and  to  help  on  the  retarded  brain- 
development.  Some  of  these  cases  are  probably  due  to  polio- 
encephalitis,  congenital  encephalitis,  or  meningo-encephalitis. 
They  are  therefore  chronic  cases  by  the  time  they  come  under 
our  treatment,  and  call  for  the  ordinary  treatment  given  chronic 
paraplegia,  hemiplegia,  etc.  It  is  seen  to  be  absolutely  necessary 


PRACTICE    OF    OSTEOPATHY.  313 

to  devote  much  treatment  to  increasing  spinal  and  cerebral  cir- 
culation, as  before  described,  for  the  purpose  of  repairing  the 
tissue  changes  that  have  taken  place,  in  the  form  of  sclerosis, 
vessel  changes,  etc. 

Spastic  cases  should  be  treated  as  directed  for  spastic  par- 
aplegia. 

Prophylactic  treatment  should  be  given  to  avoid  such  se- 
quelae as  epilepsy,  choreic  affections,  tremors,  athetosis,  etc. 

Generally  speaking,  these  cases  should  receive  very  careful 
systematic  training  to  develop  and  control  the  muscles. 

In  such  cases  as  are  affected  by  general  convulsions  or  spasms 
of  certain  muscle  groups,  one  may  employ,  to  control  such  man- 
ifestations, hot  baths  (with  mustard),  enemata,  etc. 

INFANTILE  CONVULSIONS. 

(ECLAMPSIA.) 

Various  kinds  of  convulsive  attacks  occur  in  children,  some- 
times soon  after  birth,  generally  later.  They  may  be  due  to 
much  the  same  style  of  lesion  as  noted  for  infantile  paralysis. 
Cervical  lesion  is  common,  leading  to  congestive  conditions  of 
the  brain,  cord,  and  meninges,  and  causing  the  convulsions. 

A  far  more  common  cause  is  lesion  to  that  portion  of  the 
spine  concerned  in  innervation  of  the  gastro-intestinal  tract. 
Gastro-intestinal  irritation  and  debility  result,  and  cause  the 
condition.  An  overloaded  stomach,  intestinal  parasites,  denti- 
tion, phimosis,  and  other  sources  of  irritation  may  be  expected. 
The  condition  is  frequently  secondary  to  rickets,  infectious  dis- 
eases, etc. 

The  PROGNOSIS  in  the  ordinary  case  of  convulsions  in  a 
child  is  good.  It  must  be  guarded  in  many  cases. 

The  TREATMENT  at  the  time  of  the  seizure  must  be  to  re- 
lax the  spasms  of  the  muscles,  and  to  draw  the  blood  away  from 
brain  and  cord,  equalizing  circulation.  Strong  inhibition  at  the 
superior  cervical  region  is  the  first  step.  The  inhibition  may  be 
•carried  on  down  along  the  spine.  It  is  usually  best  given  with 
the  patient  lying  on  the  side,  while  the  spine  is  sprung  and  held 
at  various  points,  relaxing  the  tissues  and  inhibiting  the  nerves. 
Sometimes  the  convulsion  is  at  once  relieved  by  continued  strong 


314  PRACTICE    OF    OSTEOPATHY. 

inhibition  at  the  superior  cervical,  splanchnic,  and  lower  lumbar 
regions.  This  treatment  acts  by  reaching,  at  these  several  places, 
the  important  vaso-motors  in  the  spinal  system.  Warm  baths 
are  effective  in  checking  convulsions,  also  one  may  make  cold 
applications  to  the  head. 

Further  aid  is  given  to  equalizing  the  circulation  by  the  re- 
laxing, inhibitive  abdominal  treatment  before  described. 

Attention  must  at  once  be  given  to  the  bony  lesion,  either 
re-adjusting  it  or  relaxing  the  bony  parts  and  tissues  about  it, 
in  order  to  relieve  the  irritation  from  this  source.  All  sources 
of  reflex  irritation  are  to  be  sought  out  and  removed.  Especial 
attention  must  be  given  to  gastro-intestinal  affections  so  often 
present.  They  are  to  be  treated,  according  to  their  kind,  as 
directed  in  the  chapter  on  diseases  of  this  region,  In  cases  of  an 
overloaded  stomach  the  child  should  be  caused  to  vomit.  In 
enteritis  an  enema  will  afford  immediate  relief. 

Later  the  general  health  should  be  attended  to.  Lesions 
should  be  removed,  and  a  thorough  course  of  spinal  treatment 
should  be  gone  through. 

ANGIONEUROTIC  '  EDEMA,  or  acute  circumscribed  edema, 
is  a  condition  in  which  there  is  localized'  edema  in  the  skin  or 
mucous  membranes.  It  is  to  be  treated  by  removal  of  obstruc- 
tion to  the  nerves  supplying  the  part  involved,  and  to  the  venous 
and  lymphatic  drainage  of  the  part.  The  heart  and  general 
circulation  should  be  stimulated.  The  condition  of  the  nervous 
system  must  be  looked  after,  as  nervous  disturbances  in  the  pa- 
tient favor  the  occurrence  of  the  edema.  He  should  be  quiet, 
and  the  general  spinal  and  cervical  treatment  should  be  used. 
Gastro-intestinal  disorder  may  be  present  and  should  be  looked  to. 

ERYTHROMELGIA,  or  red  neuralgia,  "is  a  chronic  disease 
in  which  a  part  of  the  body — usually  one  or  more  extremities — 
suffers  with  pain,  flushing,  and  local  fever,  made  far  worse  if 
the  parts  hang  down.5'  (Weir  Mitchell). 

CASE:  T.  F.,  aet.  47,  farmer,  affected  with  erythromelalgia 
in  both  lower  limbs.  The  feet  were  both  affected,  but  the  trouble 
never  progressed  above  the  ankles.  They  suffered  from  erupt- 
ions, fever,  redness,  distended  veins,  and  great  pain.  The  symp- 
toms were  aggravated  when  the  patient  stood,  or  let  the  limbs 


PRACTICE    OF    OSTEOPATHY.  315 

hang  down.  Elevation  of  them  afforded  relief.  Lesion  was 
found  in  posterior  condition  of  the  lumbar  vertebra,  and  of  both 
innominate  bones.  The  case  was  observed  for  some  eight  months. 
It  had  been  practically  cured  at  the  time  of  this  report. 

It  is  induced  by  exposure,  rheumatism,  a  nervous  temper- 
ament, occupations  which  require  standing,  abuse  of  alcohol, 
and  traumatism.  One  finds  lesions  affecting  the  origin  of  the 
nerve-supply  of  the  parts  affected,  or  interfering  with  the  cir- 
culation, thus  weakening  the  parts  and  laying  them  liable  to  the 
action  of  the  various  exciting  causes  of  the  diseases. 

It  should  be  treated  as  are  neuralgia  and  sciatica,  q.  v. 
Ice  cold  applications  afford  relief,  and  rest  with  the  limb  placed 
in  the  horizontal  position  is  recommended.  Headache,  dizzi- 
ness, palpitation  of  the  heart,  and  fainting,  if  present,  should  be 
treated  as  before  directed.  Tonic  treatment  to  the  nervous 
system  fortifies  against  the  prominent  tendency  of  the  condition 
to  recur. 

MENIERE'S  DISEASE,  or  aural  vertigo,  is  a  disease  of  the 
labyrinth  accompanied  by  vertigo,  deafness,  noises  in  the  earr 
vomiting,  etc.,  usually  occurring  in  the  elderly. 

The  lesions  are  such  as  are  found  in  the  great  majority  of 
ear  cases,  namely ;  of  the  atlas,  axis,  and  upper  cervical  vertebrae 
particularly.  These  may  weaken  the  nerve-supply  and  circu- 
lation to  the  ears,  and  lay  the  patient  liable  to  such  direct  ex- 
citing causes  as  exposure,  gout,  congestion,  syphilis,  irritation 
due  to  gastric  disturbance,  etc. 

The  TREATMENT  is  directed  to  the  removal  of  lesion,  and 
to  the  direct  exciting  cause  or  disease.  The  main  treatment, 
locally,  should  be  cervical,  and  of  the  sort  described  in  ear  dis- 
eases. (See  lesions,  treatment,  and  anatomical  relations  in  Dis- 
eases of  the  Ear). 

Treatment  should  be  directed  especially  to  the  prevention 
of  deafness.  Cases  may  fully  recover.  Symptoms  at  the  time 
of  attack  may  be  treated  as  necessary.  Counter-irritation  over 
the  mastoid  process  is  recommended. 


316  PRACTICE  OF  OSTEOPATHY. 

DISEASES  OF  THE  MUSCLES. 

MYOTONIA  CONGENITA,  or  Thomson's  disease,  "is  character- 
ized by  prolonged  contraction  of  the  muscles  concerned  in  vol- 
untary movements  when  brought  into  action."  This  disease 
is  said  to  be  the  rarest  in  medicine,  and  medical  texts  say  that  the 
disease  cannot  be  cured,  while  practically  nothing  can  be  done 
by  treatment.  One  case  has  come  under  osteopathic  treatment, 
and  was  cured.  It  had  been  examined  by  numerous  physicians 
and  had  been  under  the  care  of  a  celebrated  neurologist,  who 
had  made  special  mention  of  the  case  as  a  typical  one  of  Thorn- 
sen's  disease.  The  case  was  cured  merely  by  removal  of  spinal 
lesion,  and  by  general  spinal  treatment.  (See  the  "Journal  of 
Osteopathy,"  Feby.  1899,  p.  439). 

The  lesions  were  of  the  6th,  llth,  and  12th  dorsal  vertebrae 
.and  of  the  1st,  2nd,  3rd,  and  5th  lumbar.  A  report  of  the  case 
10  months  after  the  cure  showed  the  patient  still  entirely  well. 

The  various  forms  of  IDIOPATHIC  MUSCULAR  ATROPHY  and 
HYPERTROPHY;  pseudohypertrophic  muscular  paralysis,  the  ju- 
venile form  of  progressive  muscular  atrophy,  and  the  facioscapulo- 
humeral  form,  all  call  for  general  spinal  and  muscular  treatment. 
The  central  nervous  sytem  is  held  to  be  normal,  as  in  the  case  of 
myotonia  congenita,  and  the  disease  is  said  to  effect  the  muscles 
alone.  Yet,  in  myotonia  congenita  removal  of  spinal  lesion  and 
spinal  treatment  cured  the  case.  It  seems  at  least  that  treatment 
to  the  spinal  system  of  nerves,  as  well  as  spinal  lesion  to  them 
has  a  marked  effect  upon  these  idiopathic  muscular  conditions. 

Flexion,  extension,  rotation,  etc.,  of  the  lirnbs  and  parts 
constitutes  the  muscular  treatment  for  them. 

Symptomatic  treatment  may  be  added  as  necessary. 

NEURALGIA. 

CASES:  (1)  Severe  facial  neuralgia  of  two  weeks  standing, 
with  inflammatory  eruption  upon  the  affected  side,  the  right, 
and  inflammation  of  the  right  eye.  The  usual  treatments  had 
been  tried  for  two  weeks  without  avail.  The  lesion  was  a  marked 
displacement  of  the  atlas  to  the  left.  It  was  corrected  and  the 
case  was  cured  in  one  treatment. 


PRACTICE    OF    OSTEOPATHY.  317 

(2)  Facial  neuralgia  affecting  the  right  side  of  the  face  and 
head,  especially  the  forehead  over  the  right  eye.     The  lesion  was 
luxation  of  the  atlas  to  the  left.     The  case  was  cured  in  one  treat- 
ment. 

(3)  Facial  neuralgia  of  two  years  standing  was  greatly  re- 
lieved by  one  treatment  and  was  cured  in  six  weeks,  the  patient 
gaining  twenty-two  pounds  during  that  time. 

(4)  Facial    neuralgia    and    pains    between    the     shoulders. 
The  lesions  were  contraction  of  cervical  muscles  and  lateral  lux- 
ation of  the  fourth  and  fifth  dorsal  vertebrae.     Four  treatments 
cured  the  case. 

(5)  Brachial  neuralgia,  involving  the  left  arm  and  the  left 
side  as  low  as  the  fifth  rib.     The  pain  was  intense,  and  the  case 
was  of  more  than  two  years  standing.     The  arm  was  wasted  and 
the  pain   continuous.     Lesions  were  a  lateral  luxation   of  the 
second  dorsal  vertebra,  and  contraction  of  the  muscles  of  the 
upper  spinal  region  as  low  as  the  sixth  dorsal  vertebra,  drawing 
together  the  upper  five  ribs  on  the  left  side  and  causing  inter- 
costal neuralgia  in  this  region.     In  two  weeks  the  pain  was  over- 
come and  the  arm  began  to  develop.     The  case  was  cured. 

(6)  Brachial   neuralgia   of  more  than   one  years  standing. 
The  pain  affected  the  right  arm  and  rendered  it  almost  useless. 
The  lesion  was  of  the  right  first  rib,  pressing  upon  the  brachial 
plexus.     At  the  third  treatment  the  rib  was  set  and  the  pain 
ceased. 

(7)  Cervico-brachial  neuralgia  in  the  right  arm,  shoulder, 
and  chest,  due  to  lateral  luxation  of  the  5th  cervical  and  third 
dorsal  vertebrae  and  muscular  contractures  of  the  cervical  and 
left  intercostal  muscles.     The  case  was  practically  cured  in  four 
months. 

(8)  Intercostal  neuralgia  of  several  years  standing,   cured 
in  less  than  one  month.     Spinal  and  rib  lesion  corrected. 

(9)  Intercostal   neuralgia   due   to   heavy   lifting,    so   severe 
that  the  patient  was  unable  to  sit  erect  without  great  pain.     Le- ' 
sion  was  depression  of  the  3rd  and  4th  ribs  on  both  sides.     Im- 
mediate relief  followed  treatment,  and  the  case  was  cured  in  four 
weeks. 

(10)  Intercostal   neuralgia   of   ten   years   standing,    causing 


318  PRACTICE    OF    OSTEOPATHY. 

an  intense  pain  in  the  left  side,  extending  to  the  abdomen.  Le- 
sion was  a  luxation  of  the  8th  left  rib,  and  the  case  was  cured  by 
replacing  it. 

(11)  Spinal  neuralgia  of  a  number  of  years  standing,  due  to 
lesion  of  the  4th  dorsal  vertebra.     The  case  was  cured  in  two 
months. 

(12)  Neuralgia  in  the  head,  of  eight  years  standing,  lasting 
continually  thirty-six  hours  during  each'  menstrual  period.     Le- 
sion was  at  the  atlas,  with  muscular  contractions  in  the  lower 
dorsal  and  lumbar  region.     The  case  was  cured  in  one  month. 

(13)  Neuralgia    of    the    stomach    of    three    years    standing, 
the  attacks  coming  on  after  each  meal.     At  the  time  of  exami- 
nation so  serious  had  the  condition  become  that  the  patient  had 
not  taken  solid  food  for  more  than  two  weeks.     Lesion  was  a 
lateral  twist  of  the  spine  between  the  6th  and  7th  dorsal  verte- 
brae.    Improvement  followed  one  treatment,  and  the  case  was 
cured  in  about  one  year.  i 

(14)  Ulnar  neuralgia,  accompanied  by  swelling  of  the  arm 
and  of  the  ulnar  side  of  forearm,  hand,  and  third  and     fourth 
fingers.     The  trouble*  was  of  two  years  duration,  spinal  lesion 
was  found  at  the  origin  of  the  brachial  plexus,  and  a  contraction 
of  the  muscles  in  the  upper  dorsal  region.     After  four  treatments 
there  was  no  further  pain,  and  the  case  was  dismissed  cured  in 
one  month. 

(15)  Neuralgia  in  the  third  finger  of  the  right  hand,  of  sev- 
eral years  standing.     Lesion  was  at  the  third  cervical  vertebra, 
which  was  corrected  in  a  few  treatments,  removing  the  condit- 
ion. 

(16)  Tic  Douloureux  of  twelve  years  standing.     The  pain 
would  occur  spasmodically  in  the  infar-orbital  terminals  of  the 
fifth  nerve,  at  intervals  of  from  three  to  ten  minutes.     Lesion 
was  found  in  a  displaced  atlas,  which  was  corrected  in  six  weeks, 
curing  the  case. 

DEFINITION:  "Neuralgia  is  a  pain  in  the  course  of  a  nerve 
unaccompanied  by  structural  changes."  It  is  due  to  irritation, 
direct  or  indirect,  of  the  nerve.  Often  this  irritation  is  from 
pressure  of  a  displaced  bony  part  or  of  contractured  tissues. 

The  LESIONS  found  causing  this  condition  ?.re  usually  bony, 


PRACTICE  OF  OSTEOPATHY.  319 

and  these  act  by  pressing  directly  upon  a  nerve  or  by  affecting 
centers  or  sympathetic  connections.  In  case  6  above,  the  brachial 
neuralgia  was  due  to  direct  pressure  of  the  first  rib  upon  the 
brachial  plexus  of  nerves.  In  case  1  or  2  it  is  evident  that  le- 
sion of  the  atlas  was  too  low  to  affect  the  nerve  involved,  the 
fifth  cranial,  by  direct  pressure.  Here  the  effect  may  have  been 
upon  the  medulla,  thus  affecting  the  center  in  which  certain 
roots  of  origin  of  the  fifth  arise,  but  more  probably  the  effect 
was  upon  the  nerve  through  its  numerous  sympathetic  conec- 
tions  in  the  upper  part  of  the  cervical  region,  as  pointed  out  in 
the  discussion  of  the  fifth-nerve  in  diseases  of  the  eye,  q.  v. 

In  intercostal  neuralgia  the  pressure  is  usually  directly  upon 
the  nerve  by  a  displaced  rib,  but  may  be  due  to  vertebral  lesion. 

The  commonest  bony  lesion  in  neuralgia  is  a  luxated  ver- 
tebra, such  a  cause  having  been  known  to  produce  neuralgia  in 
any  part  of  the  body.  (See  cases  1,  5,  7,  11,  13.)  It  is  probable 
that  in  such  cases  the  vertebra  brings  direct  pressure  upon  the 
nerve  as  it  emerges  from  the  spinal  canal. 

Any  bony  part  in  the  body  in  relation  to  nerves  may  be- 
come displaced  and  impinge  upon  the  adjacent  nerve,  causing 
neuralgia.  Frequently  the  cause  of  irritation  is  pressure  of  con- 
tractured  tissues  upon  the  nerve.  This  occurs  at  the  foramina. 
The  tissues  at  and  about  the  foramen  become  congested  or  con- 
tractured,  pressing  upon  the  nerve.  These  contractures  may 
occur  along  the  spine,  as  in  case  4.  Contractures  of  the  inter- 
costal muscles  may  draw  the  ribs  together,  irritate  the  nerves  and 
cause  the  neuralgia.  Contractures  are  often  the  direct  irritating 
cause  in  cases  of  neuralgia  due  to  exposure,  traumatism,  etc. 

The  lesion  may  be  one  causing  a  primary  disease,  as  rheu- 
matism, gout,  or  specific  infectious  disease,  allowing  of  the  gen- 
eration of  poisons  in  the  systems,  which  affect  the  nerves  by  cir- 
culating in  the  blood. 

In  Tic  DOULOUREUX  the  lesion  is  usually  at  the  atlas,  but 
often  is  found  among  the  other  upper  cervical  vertebrae.  Con- 
tracture  of  the  cervical  muscles  and  of  the  tissues  about  the 
foramina  are  often  the  causes. 

In  CERVICO-OCCIPITAL  neuralgia  the  lesions  are  usually  among 
the  upper  four  cervical  vertebrae. 


320  PRACTICE    OF   OSTEOPATHY. 

In  INTERCOSTAL  neuralgia  occur  lesions  of  vertebrae  at  the 
origin  of  the  nerves  affected,  or  of  the  ribs,  and  of  the  spinal  and 
intercostal  muscles. 

MASTODYNIA,  or  neuralgia  of  the  breast,  occurring  generally 
in  women,  is  due  to  similar  lesions  as  intercostal  neuralgia.  Com- 
monly one  finds  rib  lesion  in  the  region  affected. 

LUMBO-ABDOMINAL  neuralgia,  marked  by  pain  in  the  lum- 
bar region,  hypogastrium,   buttocks,   or  genitals,   is  caused  by 
lesion  in  the  lower  dorsal  and  lumbar  spine. 

CERVICO-BRACHIAL  neuralgia  is  due  to  lesion  of  the  lower 
cervical  vertebrae,  of  the  first  rib,  clavicle,  and  of  the  upper  dor- 
sal vertebrae.  It  may  be  caused  by  vertebral  lesion  anywhere 
from  the  atlas  to  the  sixth  dorsal. 

Neuralgia  in  the  LOWER  LIMBS  is  due  to  lumbar,  sacral  or 
innominate  lesions.  VISCERAL  NEURALGIA,  as  of  stomach  or 
intestines,  is  caused  by  vertebral  lesion  of  the  corresponding 
spinal  region.  COCCYGODYNIA  is  caused  by  displacement  of  the 
coccyx,  but  may  also  be  due  to  sacral,  lumbar,  or  innominate 
lesion,  leading  to  interference  with  the  nerves  by  pressure,  con- 
tracture  of  tissues,  etc.  Neuralgia  in  the  FEET,  in  addition  to 
spinal  and  pelvic  lesion,  is  often  due  to  lesion  of  the  small  bones 
of  the  feet.  This  is  the  case  in  MORTON'S  PAINFUL  TOE,  META- 
TAESALGIA,  etc.,  in  which  subluxaticns  among  metatarsals  or 
phalanges  cause  pressure  on  the  nerve.  These  conditions  often 
occur  in  heavy  persons  who  arc  much  on  the  feet.  Often  in  such 
persons  lithaemic,  or  gouty,  or  rheumatic  diatheses  are  present, 
and  contributing  to  the  condition.  Treatment  must  consider  the 
whole  condition.  Sometimes  the  lesion  is  difficult  of  permanent 
and  quick  adjustment,  owing  to  the  weight  of  the  person,  who  is 
more  or  less  about.  Under  such  conditions  a  well-placed  pad  of 
felt  affords  great  relief,  as  a  temporary  measure.  It  should  be 
about  1  inch,  by  2  or  3  inches,  by  ^4  inch. 

FLAT-FEET  sometimes  give  great  trouble  in  the  same  manner, 
in  the  same  class  of  cases,  namely  lithaemic,  etc.  Not  only  may 
the  feet  be  painful  and  troublesome,  but  in  some  cases  the  pain 
may  not  be  in  the  foot,  but  in  the  ankles  or  shins,  perhaps  well 
up  toward  the  knee. 

The  PROGNOSIS  is  good  in  all  kinds  of  neuralgia.     Cases  of 


PRACTICE    OF    OSTEOPATHY.  321 

long  standing  often  yield  at  once.  A  few  treatments,  or  a  single 
treatment  commonly,  at  once  relieve  the  pain.  Permanent  cure 
is  usually  accomplished. 

The  TREATMENT  is  simple.  Often  the  removal  of  lesion  is 
sufficient  to.  entirely  cure  the  condition.  The  lesion  should 
always  be  removed  as  soon  as  possible.  Likewise  any  cause  of 
irritation  must  be  removed,  as  an  ulcerated  tooth,  a  cicatrix,  a 
growth  in  the  nose,  etc.  Constitutional  conditions  giving  rise 
to  neuralgic  states  must  be  met  according  to  the  case. 

Relaxation  of  all  contractured  muscles  must  be  accom- 
plished. The  manipulation  is  carried  over  the  course  of  the  af- 
fected nerve,  relaxing  the  tissues  about  it.  The  pain  of  the 
disease  does  not  prevent  this  local  treatment.  Inhibition  of  the 
pain  is  accomplished,  not  by  pressure,  but  by  light  manipulation. 
The  main  treatment  is  usually  upon  a  lesion  at  the  origin  of  the 
affected  nerve,  or  in  its  path. 

The  above  method  of  treatment  is  applied  to  any  special 
variety  of  the  disease.  Tic  Douloureux  often  yields  at  once  to 
light  manipulation  over  the  course  of  the  affected  branches  upon' 
the  face.  (Chap.  V.  B.) 

SCIATICA. 

Sciatica  is  a  disease  in  which  Osteopathy  has  secured  par- 
ticularly brilliant  results.  Great  numbers  of  cases  have  been 
cured,  many  of  them  having  tried  previously  every  known  means 
of  treatment. 

The  PROGNOSIS  is  good.  Usually  immediate  relief  is  given 
upon  the  first  treatment.  Often  the  case  is  soon  cured,  though 
many  cases  call  for  a  patient  continuance  of  the  treatment. 

The  LESIONS  are  almost  always  of  such  a  nature  as  to  bring 
irritation  upon  the  nerve,  either  by  direct  pressure  upon  the  nerve, 
or  upon  certain  fibres  contributing  to  it.  Derangement  of  its 
blood-supply  may  play  a  part  in  producing  the  condition. 

The  common  lesions  are  bony  ones  along  the  lumbar  and 
sacral  regions.  Lesions  of  the  4th  and  5th  lumbar  vertebrae, 
lesions  of  the  first  and  second  sacral  nerves  by  contracture  of 
the  tissues  about  them,  innominate  displacement,  slipping  of  the 
sacro-iliac  joint  and  derangement  of  its  ligaments,  displacement 

21 


322  PRACTICE  OF  OSTEOPATHY. 

of  the  sacrum,  and  derangement  of  the  coccyx,  are  all  important 
forms  of  lesion  producing  sciatica.  These  lesions  impinge  the 
fibres.  Some  may  directly  press  upon  the  nerve. 

A  frequent  cause  of  sciatica  is  contracture  of  the  pyriformis 
muscle  upon  the  trunk  of  the  sciatic  nerve.  The  tissues  about 
the  sciatic  notch  may  be  contractured  and  irritate  it.  It  is  said 
that  lesion  along  the  cord,  anywhere  from  the  2nd  dorsal  down, 
may  cause  sciatica.  McConnell  states  that  downward  displace- 
ment of  the  llth  or  12th  rib  may  cause  it. 

The  TREATMENT  is  simple.  It  calls  for  the  immediate  re- 
moval of  the  source  of  pressure  or  irritation  by  correction  of 
lesion.  A  general  relaxation  of  the  tissues  about  the  nerve  and 
about  its  connections  is  done,  due  attention  being  given  to  re- 
laxation of  ligaments,  as  at  the  sacro-iliac  articulation. 

This  relaxation  of  the  tissues  should  be  carried  along  the 
femoral  vessels,  often  thus  relieving  the  condition  in  an  im- 
portant manner.  The  tissues  along  the  course  of  the  nerve, 
at  the  sciatic  notch,  at  the  back  of  the  thigh,  and  behind  the  knee 
should  be  relaxed  also.  Strong  internal  circumduction  is  used 
to  relax  the  pyriformis  muscle. 

The  sciatic  nerve  should  be  well  stretched  by  one  of  the 
methods  described.  (Chap.  X.) 

Other  forms  of  neuritis  call  for  treatment  upon  similar  lines 
to  those  followed  in  the  treatment  of  sciatica. 

A  LOCALIZED  NEURITIS  commonly  shows  obstructive  le- 
sion to  the  nerves  supplying  the  part.  Such  lesion  is  often  the 
direct  source  of  irritation  causing  the  neuritis.  In  some  cases  it 
weakens  the  local  nerve  mechanism. 

In  BRACHIAL  NEURITIS,  a  common  lesion  is  pressure  of 
the  first  rib  or  clavicle  upon  the  brachial  plexus.  Vertebral 
lesion  in  the  cervical  and  upper  dorsal  region  (4th  cervical  to 
2nd  dorsal)  is  often  the  cause.  Lesions  of  the  upper  three  ribs. 
irritating  the  upper  two  intercostal,  which  join  the  brachial 
plexus,  may  be  causative  factors.  One  finds  also  slight  slips  at 
the  shoulder  or  elbow  joint,  contracture  of  the  cervical  muscles 
and  other  tissues,  and  contracture  of  the  tissues  along  the  course 
of  the  plexus  and  the  cords  formed  from  it. 


PRACTICE    OF    OSTEOPATHY.  323 

MULTIPLE  NEURITIS  is  almost  always  due  to  the  toxic  ef- 
fects of  alcohol. 

The  TREATMENT  in  neuritis  is  especially  to  remove  the 
source  of  irritation  to  the  nerves.  In  localized  or  brachial  neur- 
itis this  is  usually  at  once  accomplished  by  removal  of  bony  or 
muscular  lesion.  This  source  of  irritation  must  be  sought  from 
the  origin  of  the  nerves  supplying  the  part  involved  out  along 
the  course  of  them.  Relaxation  of  muscles  along  these  nerves 
is  usually  of  considerable  benefit.  Movements  should  be  used 
to  stretch  the  nerves  affected.  In  these  ways  the  circulation  to 
the  nerve  is  corrected,  and  the  inflammation  is  reduced.  Any 
toxic  condition  of  the  system  should  be  carefully  treated.  If 
the  neuritis  occurs  after  gout,  diphtheria,  influenza,  etc.,  atten- 
tion must  be  given  to  purifying  the  blood,  and  to  excreting  the 
poison  from  the  system  by  way  of  the  kidneys,  liver,  bowels,  and 
skin.  These  remarks  apply  especially  to  multiple  neuritis.  If 
it  be  due  to  excessive  use  of  alcoh'ol,  abstinence  should  be  en- 
forced. In  such  cases  treatment  must  be  given  the  whole  spinal 
system,  and  the  general  health  must  be  looked  to. 

INSANITY. 

CASES:  (1)  Farmer,  injured  while  at  work,  later  became 
insane.  Treatment  by  the  usual  methods  did  not  avail  and 
preparations  were  made  to  take  him  to  an  asylum.  He  had  been 
insane  for  some  months,  when  the  osteopathic  examination  was 
made.  Four  men  were  required  to  hold  the  patient  during  the 
examination,  so  violent  had  he  become.  Lesion  was  found  as  a 
marked  displacement  of  the  third  cervical  vertebra  to  the  right. 
It  was  set  at  once,  and  the  patient  immediately  fell  asleep,  sleep- 
ing for  twelve  hours  and  awaking  rational.  In  a  few  days  the 
patient  was  well. 

(2)  A  young  lady,  violently   insane   for  six  years.     Lesion 
was  found  as  a  slightly  misplaced  atlas,  which  was  corrected  at 
one  treatment.     The  symptoms  of  insanity  all  disappeared  in  a 
few  days.     There  was  history  of  a  fall  six  years  previous  to  the 
development  of  the  insanity,  and  it  was  thought  that  the  luxa- 
tion of  the  atlas  was  'caused  then. 

(3)  A   young   woman   of   twenty-four,   insane   and   confined 


324  PRACTICE   OF   OSTEOPATHY. 

in  an  asylum  for  eight  months.  Lesion  existed  in  the  form  of 
a  double  lateral  curvature  in  the  lumbo-dorsal  region;  5th  lum- 
bar vertebra  posterior;.  4th  dorsal  markedly  posterior;  3rd  and 
5th  dorsal  anterior;  7th  and  8th  right  ribs  pressing  upon  the  liver; 
innominates,  one  forward  and  the  other  back,  one  limb  being 
1  inch  longer  than  the  other.  Treatment  directed  to  the  cor- 
rection of  these  lesions  caused  immediate  benefit,  and  the  pa- 
tient was  apparently  well  after  two  weeks  treatment. 

(4)  In  a  lady  of  twenty,  insanity  of  two  months  standing. 
There  was  a  history  of  attacks  of  marked  cerebral  congestion. 
At  times  she  became  violent.     The  lesions  were  great  tender- 
ness and  tension  in  the  cervical  region  above  the  4th  vertebra, 
but  no  bony  lesion;  tenderness  at  the  5th  lumbar  vertebra  and 
over  the  left   ovary.     Dysmenorrhoea  was  present.     After  the 
first  treatment  she  slept  for  eleven  hours,  and  awoke   sane  for 
the  first  time  in  eight  months.     After  three  weeks  treatment 
the  patient  was  well. 

(5)  A  boy  acted  in  an  insane  manner  after  a  fall  upon  his 
head  from  a  window.     A  cervical  vertebra  was  found  luxated, 
and  one  treatment  sufficed  to  cure  the  case. 

(6)  A  lady  of  thirty-eight,   who  had  been  a  chronic  sufferer 
from  rheumatism,  had  become  insane  ten  years  previously  to 
treatment.     At  the  time   of  becoming  insane  the  menses  had 
ceased.     She  had  been  in  an  asylum  for  six  months,  growing 
continually   worse.     She   was   much   excited   and   suffered   hal- 
lucinations.    The  lesions  were  such  as  pertained  to  the  rheumatic 
condition;  general  muscular  contracture,  joints  somewhat  stiff- 
ened, tenderness  over  the  kidneys,  feeble  pulse,  and  subnormal 
temperature.     One  month  of  treatment  showed  great  improve- 
ment; after  two  months  the  menses  were  re-established  and  the 
mind  was  nearly  normal.     Recovery  was  complete. 

(7)  Insanity  in  a  man  followed  injury  in  a  runaway  accident. 
Lesion  existed  as  anterior  displacement  of  the  atlas  and  a  twist. 
of  the  second  and  third  vertebrae,  one  being  turned  forward  and 
the  other  backward.     There  was  also  contraction  and  soreness 
of  the  posterior  cervical  muscles.     Continued  pain  existed  at  the 
top  of  the  head,  there  was  an  eruption  upon  the  face,  and  a 


PRACTICE    OF   OSTEOPATHY.  325 

marked  abnormal  pulsation  of  the  abdominal  aorta.  Treatment 
soon  cured  the  case. 

(8)  Insanity  of  three  weeks  standing  in  a  lady,  in  whose  case 
the  cause  was  found  to  be  an  anteversion  of  the  uterus.  A  fact 
that  had  been  quite  overlooked  in  her  long  course  of  medical 
treatment.  Osteopathic  treatment  was  given  this  condition,  and 
the  drugs  were  discontinued.  In  two  weeks  the  patient  became 
rational,  and  in  seven  weeks  was  entirely  cured. 

The  cases  are  illustrative  of  osteopathic  practice  in  insanity, 
numerous  cases  of  which  come  under  treatment.  As  a  rule  bony 
lesions  are  found.  Sometimes  lesion  exists  in  the  form  of  merely 
muscular  contracture  in  the  cervical  region.  The  LESIONS  are 
generally  in  the  cervical  region.  Five  of  the  above  eight  cases 
presented  such  lesion.  Atlas  lesion  is  frequent.  In  some  cases 
are  general  spinal  lesions  leading  to  effects  upon  the  nervous  sys- 
tem. Often  marked  lesion  is  found  in  the  dorsal  region.  Mc- 
Connell  notes  the  occurrence  in  insanity  of  middle  dorsal,  renal 
splanchnic,  and  rib  lesions.  The  latter  occur  among  the  middle 
ribs  on  the  right  side.  Case  3  above  shows  such  lesions. 

Lesions  act  by  interfering  writh  cerebral  circulation,  prob- 
ably in  some  cases  by  pressure  upon  the  cord,  and  also  by  affect- 
ing the  nervous  system  and  setting  up  reflexes.  On  the  whole 
but  little  can  be  said  definitely  in  regard  to  the  pathology  of  in- 
sanity from  the  osteopathic  point  of  view.  That  lesions  exist 
as  the  cause  of  such  conditions,  and  that  their  removal  cures, 
and  alone  can  cure  them,  cannot  be  doubted  from  the  facts.  But 
just  how  lesion  is  acting  to  cause  derangement  of  the  mental 
functions  is  not  known.  It  is  noticeable  that  quick  results  usually 
follow  treatment,  as  in  the  eight  cases  above.  Often  the  patient 
falls  at  once  into  a  deep  and  lasting  sleep.  These  facts- indicate 
some  marked  and  immediate  relief  to  the  brain.  It  seems  as 
if  some  great  pressure  had  been  taken  off  the  brain,  leaving  the 
mind  free  and  Nature  unopposed  in  her  work  of  repair.  This 
is  doubtless  literally  true  in  those  cases  of  insanity  attended  by 
cerebral  congestion,  in  which  the  impeded  circulation  is  at  once 
restored  to  normal  tension  by  removal  of  that  which  impedes 
the  venous  flow  from  the  head.  When  the  lesion  is  cervical  it 
is  altogether  likely  that  its  action  upon  the  brain  is  by  deranging 


326  PRACTICE   OF    OSTEOPATHY. 

the  cerebral  circulation,  either  by  direct  pressure  upon  the  ver- 
tebral arteries  by  a  displaced  vertebra,  by  irritation  to  cervical 
sympathetics  and  the  vaso-motor  center  in  the  medulla,  or  by  a 
combination  of  these  two.  In  this  way  may  be  set  up  either 
hyperemia  or  anemia  of  the  brain.  For  example,  pressure  upon 
the  vertebral  arteries  and  irritation  to  the  vaso-motors  causing 
vaso-constriction  might  co-operate  to  cause  marked  anemia  of 
the  brain.  On  the  other  hand,  impeded  venous  return  and  in- 
creased arterial  tension  in  this  region  might  result  from  lesion 
and  cause  cerebral  hyperemia.  Many  cases  of  insanity  are  met  in 
which  there  is  hyperemia,  as  in  cases  4  and  7. 

That  hyperemia  and  anemia  are  important  in  relation  to 
insanity  is  shown  by  the  statement  of  Kellogg  that  "insanity 
from  circulatory  disorders  of  the  brain  arises  chiefly  in  intense 
hyperemic  and  anemic  forms."  That  osteopathic  lesion  pro- 
foundly affects  cerebral  circulation  is  evidenced  by  many  facts 
in  the  treatment  of  various  diseases.  The  importance  of  these 
circulatory  disturbances  is  further  indicated  by  Kellogg 's  state- 
ment that  vascular  degenerations  deprive  the  brain  of  its  cus- 
tomary blood-supply  and  also  prevent  elimination  of  the  waste 
products  of  cellular  activity.  It  is  evident  that  the  lesion  shut- 
ting off  the  arterial  supply  or  preventing  free  circulation  in  the 
brain  cquld  act  as  could  vascular  degeneration  in  producing  the 
effects  mentioned.  Kellogg  says  it  is  freely  admitted  that  there 
is  a  previous  link  in  the  chain  of  events  leading  to  insanity  from 
such  causes  as  he  mentions  above.  This  link  the  Osteopath  sup- 
plies by  noting  these  important  bony  and  other  lesions,  without 
the  removal  of  which  these  cases  fail  to  be  cured. 

It  is  likely  that  the  atlas  lesion,  so  often  found  in  insanity, 
acts  chiefly  by  deranging  the  circulation  through  its  close  rela- 
tions to  the  superior  cervical  ganglion  and  the  medulla.  It  does 
not  seem  that  this  and  other  cervical  bony  lesion  cause  direct 
pressure  upon  the  cord,  as  in  such  case  one  would  expect  par- 
alysis in  the  body  below,  yet  it  is  not  impossible  that  it  may 
press  directly  upon  the  cord,  getting  its  effect  upon  the  brain 
through  ascending  tracts. 

The  general  spinal,  vertebral  and  rib  lesions  mentioned 
may  affect  the  general  nervous  system,  as  is  known  to  be  a  fact 


PRACTICE    OF    OSTEOPATHY.  327 

from  a  study  of  nervous  diseases,  (see  Paralysis)  in  this  way 
leading  to  nervous  diseases,  reflex  and  otherwise,  which  are  at 
the  basis  of  insanity.  "All  the  (various  influences)  acting  in 
the  production  of  general  diseases  of  the  nervous  system  are 
those  fundamentally  involved  in  the  causation  of  insanity." 
(Kellogg.)  The  splanchnic,  right  rib,  and  renal  lesions  noted 
by  osteopathy  as  present  in  insanity  cases  may  cause  insanity 
through  derangement  of  kidneys,  liver  and  gastro-intestinal 
tract.  The  fact  is  noted  by  writers  upon  insanity  that  kidney 
diseases,  notably  Bright's  disease,  and  gastro-intestinal  condi- 
tions, as  gastric  and  intestinal  catarrh,  are  sometimes  closely 
associated  with  the  causation  of  insanity.  Likewise  liver  dis- 
ease is  well  known  to  be  closely  connected  with  insanity,  gall- 
stones and  icterus  being  common  in  insanity.  These  visceral 
diseases,  as  well  as  some  nervous  diseases,  seem  to  be  related  to 
insanity  through  the  vaso-motor  reflexes  they  arouse.  Kellogg 
says,  "vaso-motor  disorders  essentially  constitute  the  connecting 
link  in  the  causation  of  insanity  by  visceral  affections  and  periph- 
eral nervous  diseases.  The  vaso-motor  center  in  the  medulla 
is  under  the  reflex  control  not  alone  of  the  cerebral  cortex,  but 
of  the  entire  peripheral  distribution  of  the  sensory  nervous  sys^ 
tern,  so  that  not  only  emotional  stimuli,  but  peripheral  irritations, 
may  affect  circulatory  changes  and  variations  in  the  blood-pres- 
sure which  stand  in  proximate  relation  to  mental  disorder. ' ' 

It  is  a  well  demonstrated  fact  that  osteopathic  lesion  causes 
not  only  the  visceral  diseases,  but  likewise  marked  vaso-motor 
disorders,  etc.,  apparently  so  closely  related  to  these  brain  con- 
ditions. 

In  view  of  these  various  facts  it  seems  that  the  Osteopath 
has  in  insanity  a  broad  field  for  his  labors.  Nor  would  he  be 
confined  to  that  class  of  cases  in  which  the  traumatic  effects  of 
lesions  due  to  violent  accident  and  the  like  are  the  causes  of  in- 
sanity. But  as  it  is  evident  that  the  various  lesions,  bony  and 
otherwise,  that  he  finds  may  become  fundamental  to  the  causa- 
tion of  insanity  through  producing  visceral,  nervous,  and  vaso- 
motor  disorders,  his  field  in  insanity  must  be  as  broad  as  the  disease. 

The  PROGNOSIS  is  good.  The  most  brilliant  and  quickest 
results  are  often  attained.  A  large  percentage  of  the  cases  treated 


328  PRACTICE    OF    OSTEOPATHY. 

are  cured.     It  is  needless  to  say  that  many  cannot  be  cured. 

The  TREATMENT  looks  to  the  removal  of  lesion,  and  of  all 
causes  of  irritation,  reflex,  emotional  and  otherwise.  The  whole 
nervous  system  should  be  upbuilt  by  general  spinal  and  cervical 
treatment.  One  of  the  main  objects  is  to  correct  cerebral  circu- 
lation. A  congested  condition  is  treated  as  in  congestive  head- 
ache or  apoplexy,  q.  v.  The  abdominal  inhibition  may  be  em- 
ployed. The  general  health  is  looked  to,  kidneys,  liver,  stomach, 
bowels,  pelvic  viscera,  heart  and  lungs  are  all  regulated  in  case 
of  affection  in  them.  The  patient  should  lead  a  quiet,  regular 
life. 

DISEASES  OF  THE  EYE. 

CASES:  (1)  Impaired  vision  in  a  boy  of  seventeen,  who 
had  been  wearing  glasses  over  three  years.  Severe  headache 
and  inability  to  read  followed  removal  of  them.  Lesion  was 
found  as  lateral  luxation  of  the  atlas  and  third  ceivical  verte- 
bra. After  three  weeks  treatment  the  glasses  were  removed, 
and  at  the  end  of  two  months  the  eyes  were  completely  cured. 
The  report  was  made  six  months  later,  the  eyes  still  being  well. 

(2)  A  case  in  which  weakness  of  the  eyes  and  rheumatic 
pains  in  the  shoulder  were  caused  by  lesion  in  the  form  of  close- 
ness of  the  second  and  third  cervical  vertebrse.     After  one  treat- 
ment the  glasses  were  laid  aside  and  the  pain  in  the  shoulder 
was  gone.     The  trouble,  caused  by  a  fall  in  a  gymnasium,  affect- 
ed but  one  eye  and  one  side  of  the  body,  a  nervous  twitching  of 
the  muscles  being  present. 

(3)  A  young  lady  had  suffered  with  weak  eyes  for  two  years. 
The  eyes  would  be  very  painful  if  the  glasses  were  laid  aside 
even  for  five  minutes.     Lesion  was  of  the  2nd  dorsal  vertebra, 
lateral  to  the  left.     After  five  treatments  the  glasses  were  dis- 
carded. 

(4)  In  a  lady  of  forty,  weakness  of  the  eyes,  accompanied 
by  great  pain  in  the  eye-balls  and  at  the  base  of  the  brain.     Le- 
sion existed  at  the  atlas  and  third  cervical  vertebra.     Constipa- 
tion and  uterine  prolapsus  were  present,  with  characteristic  le- 
sions.    After  one  month  the  eyes  were  almost  well.     Photopho- 
bia was  a  feature  of  the  case. 


PRACTICE  OF  OSTEOPATHY.  329 

I 

(5)  In  a  case  of  weak  eyes,  with  pain  in  the  neck,  occipital 
headache,  and  a  complication  of  troubles,  lesions  were  found  as 
anterior  luxation  of  3rd,  4th,  and  5th  cervical  vertebrae,  the  5th 
being  sore.     The  whole  spinal  column  was  stiff  and  stooped  for- 
ward. 

(6)  In  a  case  of  weak  eyes  in  a  young  man  of  twenty,  of  two 
months  standing,  the  patient  was  unable  to  read,  the  balls  were 
injected  and  painful,  and  the  lids  were  inflamed.     The  atlas  and 
:axis  were  too  close. 

(7)  In  a  lady  of  thirty-two,  weakness  of  the  eyes  and  chronic 
hoarseness  had  existed  for  twenty-two  years.     The  left  cervical 
muscles  were  very  sore,  there  was  a  separation  between  the  atlas 
and  axis,  and  the  5th  cervical  vertebra  was  sore.     The  right  tear 
•duct  was  closed. 

(8)  In  a  case  of  weakness  of  the  eyes,  coupled  with  indi- 
gestion, jaundice  and  hemorrhoids,  the  7th  to  llth  dorsal  verte- 
bra were  posterior;  coccyx  anterior;  and  innominate  forward. 

(9)  Extreme   weakness   of  the  eyes,   together  with  female 
•disease.     A  few  minutes  use  of  the  eyes  caused  violent  head- 
.ache.     Lesions  were  at  the  atlas  and  in  a  tilting  of  an  innominate 
bone.     The  case  was  cured  by  removal  of  the  lesions. 

(10)  Eye   trouble  in   a   boy   of  thirteen,   not  benefited   by 
glasses.     Patient  was  very  nervous.     The  atlas  was  slipped  for- 
ward.    The  lesion  was  corrected  and  the  case  was  cured  in  six 
weeks. 

(11)  A  case  of  pterygium  due  to  granulated  lids  of  sixteen 
years  duration.     The  left  pupil  was  covered  by  the  growth,  and 
the  right  one  was  nearly  so.    The  case  was  cured  by  the  adjust- 
ment of  cervical  lesion. 

(12)  Pterygium   over  each  eye  due  to  lesion   of  -the  atlas. 
Under  treatment  gradual  correction  of  the  lesion  was  accompanied 
by  gradual  absorption  of  the  growth. 

(13)  Partial    blindness    and    strabismus,    associated    with 
general  paralysis,  due  to  a  forward  slip  of  the  head  upon  the  atlas. 
'The  case  was  cured  in  two  months. 

(14)  A  case  of  blindness  from  optic-nerve  atrophy,  due  to 
.a  fall  from  a  swing,  resulting  in  lesion  of  the  atlas  and  several 


330  PRACTICE    OF    OSTEOPATHY. 

cervical  and  upper  dorsal  vertebrae.     The  disease  was  of  twenty- 
three  years  standing.     It  was  cured  by  two  years  treatment. 

(15)  Blindness  of  one  eye,  and  almost  total  loss  of  sight  in  the 
other,  of  about  a  years  duration,  was  cured  in  two  weeks  by  cor- 
rection of  lesion  of  the  atlas,  which  was  displaced  to  the  right, 
and  of  one  of  the  first  ribs,  which  was  luxated  upwards. 

(16)  Partial  blindness,  the  patient  being  unable  to  read  or 
to  recognize  a  person  ten  feet  away.     The  trouble  was  due  to 
starvation  of  the  optic  nerve  from  lesion  of  the  upper  cervical 
vertebra.     In  four  months  the  patient  had  been  cured. 

(17)  Blindness,  almost  total,  in  a  man  of  sixty,  due  to  a 
fall  when  he  was  a  child.     Lesion  was  found  as  luxation  of  a 
cervical  vertebra.     The  treatment  so  benefited  the  eye  that  it 
could  see  to  read  coarse  print. 

(18)  Total  blindness  in  the  left  eye  for  more  than  two  years, 
due  to  lesion  of  the  atlas.     The  pupil  was  much  dilated.     After 
one  treatment  sight  was  partly  restored,  and  at  the  end  of  a 
month  of  treatment  the  case  was  nearly  entirely  well. 

(19)  Total  blindness  with  paralysis  of  lower  limbs,  formica- 
tion of  upper  limbs,  etc.     Lesion  was  found  in  lateral  luxation 
of  the  third  cervical  vertebra,  of  the  7th  and  8th  right  ribs,  and 
posterior  protrusion  of  the  lumbar  vertebrae.     Soon  vision  was 
partly  restored,   but   with   diplopia.     Slight  pressure   upon   the 
seventh  cervical  vertebra  would  at  once  restore  perfect  vision. 
When  pressure   was  removed   diplopia   again  occurred.     Lrnder 
the  treatment  the  sight  was  entirely  restored.     Speech  had  been 
lacking,  but  was  restored,  and  the  paralysis  was  cured. 

(20)  In  a  young  man  of  twenty,  diplopia  of  two  years  dura- 
tion had  followed  a  severe  attack  of  measles.     The  3rd  cervical 
vertebra  was  displaced  anteriorly  and  the  tissues  about  it  were 
sore.     Tenderness  existed  also  at  the  5th  and  6th  cervical  verte- 
brae.    The  first  dorsal  was  posterior,  the  2nd  to  6th  flattened, 
the  8th  to  12th  weak,  with  a  separation  between  the  12th  dorsal 
and  1st  lumbar,  and  the  1st  to  4th  lumbar  vertebras  were  pos- 
terior.    The   case  was   cured   in   one   month.     There   had   been 
supposed  hemorrhagic  retinitis. 

(21)  A  case  of  strabismus  due  to  lesion  of  the  2nd  dorsal 
vertebra   was   cured   by   correction   of   the   lesion.     During  the 


PRACTICE    OF    OSTEOPATHY.  331 

course  of  treatment,  after  the  eyes  had  first  become  straight- 
ened, pressure  upon  the  second  dorsal  vertebra  would  cross  them 
again. 

(22)  A  case  of  strabismus,  unilateral,  convergent,  due  to  a 
fall  in  a  runaway  accident.     The  atlas  was  displaced  to  the  right; 
4th  and  5th  cervical  vertebrae  anterior.     The  case  was  improving 
under   treatment. 

(23)  Kerito-conjunctivitis,    in   the   left   eye,    of   four   years 
standing.     There  was  opacity   of  the  upper  two-thirds  of  the 
cornea,  with  marked  vascularization,  inflammation  and  granula- 
tion of  the  eyelids,  and  injection  of  the  sclerotic.     The  atlas  was 
luxated  to  the  left,  the  fifth  and  sixth  cervical  vertebrae  were 
anterior  and  to  the  left,  and  the  upper  dorsal  vertebrae  were  pos- 
terior.    Under  the  treatment  the  case  was  almost  cured  in  less 
than  two  months. 

(24)  In  a  man  of  thirty-seven,  glaucoma  was  present,  and 
total  blindness  of  the  left  eye  was  predicted  by  the  oculist.     The 
patient  was  a  neurasthenic,  probably  of  the  cerebral  type,  pain 
in  the  head  and  eye  being  extreme.     The  eye-trouble  was  over- 
come  and  the  patient's  general   condition   much  improved  by 
three  months  treatment.     No  special  lesions  were  found. 

(25)  Partial  blindness,  in  which  the  blindness  was  limited 
to  a  circular  portion  of  each  eye.     Lesion  was  found  as  a  luxa- 
tion of  the  atlas  to  the  right  and  backwards.     The  case  is  still 
under  treatment. 

(26)  A   case   in   which   the   tear-duct   was   closed.     It   had 
been  growing  worse  under  the  usual  form  of  treatment  for  two 
years.     The  eye  was  much  inflamed.     Relief  was  experienced 
at  the  first  treatment,  after  the  second  the  duct  was  permanently 
opened,  and  the  inflammation  about  the  eye  gradually   disap- 
peared.    The  case  was  well  a  year  later. 

(27)  Eye-strairi,    causing     constant    headache,    due    to    a 
luxated  atlas.     Glasses  gave  no  relief.     The  headache  did  not 
recur  after  the  first  treatment,  and  the  eyes  were  well  after  seven 
treatments.     The  case  had  been  of  but  two  or  three  months 
standing. 

(28)  Astigmatism  in  a  girl  of  ten.     Lesion  was  found  at 
the  2nd  dorsal.     Treatment  was  directed  to  correction  of  this 


332  PRACTICE  OF  OSTEOPATHY. 

lesion  and    to  stimulation  of  the  ocular  blood  and  nerve-supply. 
The  case  was  soon  cured. 

(29)  In  astigmatism  for  which  the  patient  had  worn  spec- 
tacles for  nine  years,  lesion  was  found  in  anterior  luxation  of  the 
atlas  and  a  twist  of  the  inferior  maxillary  bone.  The  glasses  were 
permanently  discarded  after  one  treatment,  and  the  case  was 
soon  entirely  cured. 

These  reports  illustrate  very  well  the  general  lesions  found 
in  diseases  of  the  eye.  The  most  important  lesions  occur  among 
the  vertebrae  of  the  cervical  and  upper  dorsal  region.  Muscular 
lesions  are  often  found  in  this  region,  and  are  of  considerable 
importance.  The  whole  cervical  region  is  frequently  involved, 
or  any  one  or  several  of  the  vertebra  may  be  luxated.  Perhaps 
the  more  important  lesions  are  of  the  atlas,  axis,  and  3rd  cervical 
vertebra.  The  4th  and  5th  are  also  important. 

Other  bony  lesions  occurring  in  these  cases,  and  of  import- 
ance in  eye  troubles  generally,  are  luxation  of  the  inferior  max- 
illary bone  and  of  the  first  rib,  sometimes  also  of  the  clavicle. 

There  is  a  form, of  neck  lesion  that  often  plays  a  part  in  the 
production  of  eye  disease,  as  well  as  of  other  forms  of  head  and 
neck  trouble.  It  involves  the  whole  cervical  region,  often  causing 
a  lateral  swerve  of  the  cervical  spine.  The  cervical  tissues  are 
contractured  or  hypertrophied  upon  one  side  more  prominently 
than  upon  the  other.  The  condition  is  often  evident  upon  simple 
inspection  from  immediately  behind.  The  fullness  upon  one 
side  of  the  neck,  and  generally  a  corresponding  depression  in  the 
tissues  on  the  opposite  side,  are  readily  seen.  In  some  cases  the 
condition  is  better  appreciated  upon  palpation.  The  fingers 
are  readily  pressed  more  deeply  into  the  tissues  upon  one  side 
of  the  posterior  cervical  aspect  than  upon  the  other.  Contrac- 
ture  of  the  muscles  may  be  felt  here  on  both  sides.  If  the  verte- 
brae are  traced  down  the  mid-line  of  the  back  of  the  neck,  a  lateral 
swerve  is  often  evident.  In  other  cases  the  bony  lesions  are 
more  evident  by  examination  of  each  vertebra  with  the  patient 
lying  upon  his  back. 

Dr.  A.  T.  Still  calls  attention  to  the  fact  that  contracture 
of  the  cervical  muscles  opposite  the  4th  vertebra  are  common 
.in  eye-diseases,  and  that  pressure  here  causes  pain  in  the  eye. 


PRACTICE    OF    OSTEOPATHY.  333 

A  case  is  reported  in  which  pressure  between  the  2nd  and  3rd 
dorsal  vertebrae  upon  the  right  side  revealed  tenderness  at  that 
point  and  also  caused  pain  in  the  eye. 

Without  question  cervical  bony  lesion  is  the  most  important 
one  with  which  the  Osteopath  deals  in  eye-diseases. 

Upper  dorsal  lesion  may  be  muscular,  but  is  usually  bony. 
It  involves  chiefly  the  upper  four  or  five  vertebrae,  but  may  ex- 
extend  as  low  as  the  6th  or  7th.  The  lesions  of  the  1st,  2nd  and 
3rd  dorsal  vertebras  are  the  most  important  here.  A  common 
abnormality  of  the  anatomical  parts  here  is  a  "hump"  or  prom- 
inent cushion  of  flesh  covering  the  spinous  processes  of  the  upper 
two  or  three  dorsal  vertebrae.  There  is  often  conjoined  with  this 
condition  a  marked  prominence  of  the  first  dorsal  spine  from 
above,  as  if  the  cervical  spine  had  been  moved  a  little  anteriorly 
upon  the  first  dorsal.  This  cushion  is  a  common  condition  in 
eye  troubles  of  various  sorts,  and  is  sometimes  connected  with 
heart-trouble. 

Among  lesions  of  this  region  may  be  mentioned  lesion  of 
the  upper  ribs  on  either  side  as  low  as  the  sixth,  sometimes 
thought  to  have  bearing  upon  nutritional  disturbances  of  the 
eyes. 

We  are  perhaps  not  in  a  position  as  yet  to  point  out  that 
special  kinds  or  locations  of  lesion  result  in  specific  diseases  of 
the  eye.  Cases  involving  deficiency  somewhere  in  the  optic 
tract  seem  to  favor  lesion  in  the  upper  cervical  region.  In  the 
above  reports,  19  cases  in  which  probably  the  intrinsic  appara- 
tus of  the  special  sense  of  sight  was  involved,  such  as  weakness, 
impaired  vision,  blindness,  etc.,  show  lesion  chiefly  in  the  upper 
cervical  region.  All  but  2  cases  show  cervical  lesion,  13  of  them 
being  entirely  in  the  cervical  region;  11  at  the  atlas;  8  at  the 
axis,  third,  or  both;  also  the  4th,  5th  and  7th  were  involved.  The 
most  important  lesions  occurred  about  atlas,  axis  and  third. 

Cases  in  which  there  is  nutritional  disturbance,  as  in  con- 
junctivitis, keratitis,  glaucoma,  cataract,  and  closure  of  the 
tear-duct,  also  cases  in  which  there  is  structural  change,  such  as 
astigmatism,  pterygium,  etc.,  probably  due  to  lack  of  nutrition, 
present  atlas,  general  cervical,  inferior  maxillary,  and  upper 
dorsal  lesion.  Compilations  of  data,  by  which  proof  of  these 


334  .       PRACTICE    OF    OSTEOPATHY. 

might  be  made,  are  lacking.  Yet  it  seems  that  nutritional  dis- 
turbances, involving  in  some  way  chiefly  the  fifth  nerve,  would 
be  found  tending  more  toward  the  upper  dorsal  region,  for  the 
anatomical  reason  that  this  nerve  has  important  connections  with 
the  upper  dorsal  nerves  and  cord. 

Motor  disturbances,  such  as  diplopia,  strabismus,  eye- 
strain,  etc.,  show  less  of  high  cervical  lesion  and  more  from  about 
the  third  cervical  down  to  the  upper  dorsal.  In  this  connection 
it  is  recalled  that  diplopia  has  been  caused  by  pressure  at  the  7th 
cervical,  and  strabismus  by  pressure  at  the  2nd  dorsal. 

This  phase  of  the  subject,  inquiry  how  far  specific  lesion  re- 
sults in  certain  forms  of  eye  disease,  presents  a  good  field  for 
research.  It  is  evident  that  at  present  we  cannot  more  than 
indicate  probabilities. 

ANATOMICAL  RELATIONS:  There  are  good  anatomical  rea- 
sons why  lesion  in  the  upper  dorsal  and  cervical  regions  causes 
eye  disease.  These  portions  of  the  spine  are  particularly  rich 
in  nerve  connections  with  the  eye.  These  lesions  act  by  dis- 
turbing blood,  nerve,  or  lymphatic-supply  of  the  eye.  The  blood- 
supply  suffers  sometimes  by  direct  impingement,  as  of  vertebrae 
upon  the  vertebral  arteries,  or  by  derangement  of  the  vaso-motor 
control  by  lesion  to  the  nerves.  The  lymphatics  suffer  by  direct 
impingement,  as  by  clavicular  lesion  damming  back  the  lymphatic- 
drainage  from  the  head.  The  lesion  affecting  the  eye  does  so 
chiefly,  however,  by  disturbance  of  the  numerous  important  nerve- 
connections  met  in  the  upper  dorsal  and  cervical  regions. 

Experience  has  taught  the  Osteopath  that  bony  lesion  in 
those  regions  causes  most  eye-diseases  and  that  its  removal  cures 
them. 

The  superior  cervical  ganglion,  well  known  to  suffer  by 
lesion  of  atlas,  axis,  or  3rd  cervical,  sends  its  ascending  branch 
to  join  the  carotid  and  cavernous  plexuses,  thence  to  help  form 
a  secondary  plexus  about  the  ophthalmic  arteries  and  to  con- 
tribute branches  to  the  minute  plexus  of  the  sympathetic  within 
the  eye-ball  itself.  Thus  is  established  a  direct  path  of  com- 
munication between  the  upper  cervical  lesion  and  the  eye. 

The  ciliary  ganglion  lies  at  the  back  of  the  orbit,  between 
the  trunk  of  the  optic  nerve  and  the  external  rectus  muscle. 


PRACTICE    OF   OSTEOPATHY. 

In  this  situation  it  is  readily  impinged  by  that  treatment  that 
presses  the  eyeball  back  into  the  orbit.  With  this  ganglion  are 
connected  the  3rd,  5th,  and  sympathetic  nerves,  it  thus  becom- 
ing, through  the  functions  of  these  nerves,  a  sensory,  motor, 
and  sympathetic  center  for  the  eye-ball.  Neck  lesion,  as  will  be 
shown,  may  effect  either  or  all  of  these  nerve-connections,  in  this 
way  deranging  the  function  of  the  ganglion  with  regard  to  the  eye. 

The  third  cranial  nerve  innervates  all  the  voluntary  mus- 
cles of  the  -eye  except  the  external  rectus  and  the  superior  ob- 
lique. It  is,  further,  the  nerve  which  contracts  the  pupil  by  sup- 
plying the  sphincter  function  of  the  iris.  This  function  is  shown 
by  the  American  Text-Book  of  Physiology  to  have  its  center  in 
the  superior  cervical  ganglion,  where  it  could  be  affected  in  le- 
sion of  the  upper  cervical  region,  causing  disturbance  of  accom- 
modation in  the  eye.  Neck  lesions  are  knowrn  to  cause  strabis- 
mus and  diplopia  (cases  19  and  21),  showing  disturbance  by  such 
lesion  of  the  function  of  the  3rd  nerve.  (Also  of  the  4th  and  6th). 
The  anatomical  relations  in  strabismus  caused  by  lesion  at  the 
2nd  dorsal,  and  in  diplopia  by  lesion  at  the  7th  cervical,  are  not 
well  understood.  The  local  treatment  of  the  ciliary  ganglion  is 
important  in  these  motor  disturbances. 

Fibers  antagonistic  to  the  ciliary  function  of  the  third  nerve, 
being  dilators  of  the  pupil,  are  found  rising  in  the  third  ventricle, 
whence  they  pass  through  the  medulla  and  cervical  cord  to  the 
anterior  roots  of  the  upper  dorsal  nerves  and  to  the  first  thoracic 
ganglion  of  the  sympathetic.  From  these  points  they  reach  the 
eye  via  the  cervical  sympathetic  cord,  ophthalmic  division  of  the 
fifth,  and  its  nasal  and  long  ciliary  branches. 

These  facts  indicate  the  importance  of  upper  cervical,  gen- 
eral cervical,  and  upper  dorsal  lesion  in  the  causation  of  lack  of 
accommodation,  eye-strain,  and  similar  troubles. 

The  latter  sympathetic  connection  indicates  the  so-called 
cilio-spinal  center  at  the  4th  cervical  to  4th  dorsal.  Quain  states 
that  these  pupillo-dilator  fibers  pass  from  the  1st,  2nd  and  3rd 
nerves,  sometimes  also  from  the^Tth  and  8th  cervical. 

In  addition  to  the  above,  motor  fibers  to  involuntary  mus- 
cles of  the  orbit  and  eye-lids  pass  from  the  upper  four  or  five 
dorsal  nerves.  Also  retinal  fibers  leave  the  sympathetic  at  the 


336  PRACTICE    OF    OSTEOPATHY. 

superior  cervical  ganglion,  pass  to  the  Gasserian  ganglion  of  the 
fifth,  thence  through  its  branches  to  the  eye.  It  is  shown  that, 
acting  through  these  fibers,  stimulation  of  the  cervical  sympa- 
thetic causes  constriction  of  the  retinal  arteries,  while  stimula- 
tion of  the  thoracic  sympathetic  causes  dilatation  of  them.  These 
facts  indicate  the  importance  of  cervical  and  upper  dorsal  lesion 
in  vaso-motor  disturbances  in  the  retina,  as  in  retinitis. 

The  fact  that  many  of  these  sympathetics,  as  pointed  out, 
pass  to  the  eye  via  the  fifth  nerve  shows  the  intimate  relation 
between  the  superior  cervical  ganglion,  the  cervical  and  upper  dor- 
sal sympathetic,  and  the  fifth  nerve,  consequently  the  potency  of 
cervical  and  upper  dorsal  lesion  to  affect  the  fifth  nerve.  This 
nerve  sends  its  sensory  ophthalmic  division  to  join  with  the 
sympathetic  from  the  cavernous  plexus.  It  has  trophic  and  vaso- 
motor  fibers  to  the  eyeball  and  its  appendages.  Green  states 
that  section  of  the  fifth  nerve  is  followed  by  keratitis  and  ulcera- 
tion.  It  has  charge  of  the  nutrition  of  the  eye-ball,  supplying 
also  the  lachrymal  glands,  conjunctiva,  skin  of  the  lids  and  ad- 
jacent parts  of  the  face.  *Nutritive  disturbances  of  the  eyes, 
such  as  keratitis,  conjunctivitis,  retinitis,  cataract,  glaucoma, 
pterygium,  etc.,  must  be  referred  to  lesion  affecting  the  fifth  nerve. 
Likewise  optic  nerve  atrophy,  and  other  effects  due  to  insufficient 
nutrition,  would  result  from  lesion  affecting  the  fifth. 

Slips  of  the  inferior  maxillary  articulation  are  thought  to 
impinge  fibers  of  the  fifth  nerve,  (articular  branches  from  the 
auriculo-temporal  nerve)  and  to  cause  certain  eye  troubles, 
(case  33.) 

A  review  of  these  various  connections  shows  that  cervical 
and  upper  dorsal  lesion  may  affect: 

1.  The  superior  cervical  ganglion  and  its  sympathetic  con- 
nection with  the  local  sympathetic  plexus  of  the  eye-ball. 

2.  The  various  cervical  nerves,  and  through  them  the  gang- 
lion and  the  other  cervical  sympathetics. 

3.  The   pupillo-constrictor   center   in   the   superior   cervical 
ganglion. 

4.  The  pupillo-dilator  center  in  the  same  ganglion  and  at 
at  the  lower  cervical  and  upper  three  dorsal  nerves. 

5.  The  motor  fibers  from  the  upper  four  or  five  dorsal  nerves 


PRACTICE    OF    OSTEOPATHY.  '     337 

to  the  involuntary  muscles  of  orbit  and  eyelids. 

6.  The  fifth  nerve  by  its  connections  with  the  superior  cer- 
vical ganglion  and  cervical  sympathetic. 

7.  Constrictors  of  the  retinal  arteries  in  the  cervical  sym- 
pathic. 

8.  Dilators  of  the  same  in  the  thoracic  sympathetic,  and 
both  of  these  at  the  superior  cervical  ganglion. 

It  is  noticeable  that  all  of  these  eight  connections,  except 
perhaps  No.  5,  may  be  reached  at  the  superior  cervical  ganglion. 
This  explains  the  special  importance  of  lesion  to  atlas,  axis  and 
3rd  cervical,  before  pointed  out  as  most  frequent  in  eye  diseases. 
These  upper  cervical  lesions  affect  this  ganglion.  From  the 
variety  of  functions  represented  in  these  various  fibers  congrega- 
ted in  the  superior  cervical  ganglion  we  must  conclude  that 
lesion  of  the  atlas,  axis,  or  third, '  etc.,  affecting  this  ganglion, 
would  cause  a  variety  of  diseases  of  the  eye. 

Lesions  causing  stomach,  kidney,  and  pelvic  diseases  may 
secondarily  become  the  cause  of  disturbances  in  the  eye.  The 
relation  here  is  probably  entirely  reflex.  Perhaps  also  in  these 
conditions  alteration  of  blood-pressure  is  a  disturbing  factor. 

It  seems  that  cervical  lesion  causing  obstruction  of  the 
tear-duct,  as  well  as  manipulation  upon  the  nose  along  its  course 
to  open  it,  affect  the  mucous  membrane  lining  it,  through  the 
distribution  of  the  fifth  nerve. 

Clavicular  and  first  rib  lesion,  obstructing  the  lymphatic 
drainage  of  the  eye  by  obstructing  the  flow  from  the  deep  cer- 
vical lymphatics  into  the  thoracic  or  right  lymphatic  duct,  may 
affect  the  metabolism  of  the  eye.  It  has  been  thought  that  le- 
sion affecting  the  female  breast  may  react,  upon  the  eye  reflexly. 

The  PROGNOSIS  in  eye-diseases  is,  generally  speaking,  good. 
Marked  results,  even  to  cure  of  blindness  of  many  years  stand- 
ing, have  been  acquired.  Very  often  suprisingly  quick  results 
have  been  attained.  An  examination  of  the  case  reports  at  the 
opening  of  this  chapter  will  show  that  in  twenty-four  of  the 
thirty-three  various  cases  reported  a  cure  was  affected.  Quick 
results,  either  as  cure  or  benefit,  were  attained  in  seventeen  cases. 
The 'cases  met  by  the  Osteopath  are  frequently  of  long  standing 

*For  important  functions  of  the  fifth  nerve  see  "Principles  of  Osteopathy."1 

o.,  .  , 


338  PRACTICE  OF  OSTEOPATHY. 

and  in  bad  condition.  In  many  cases  these  results  were  gotten 
after  specialists  had  failed.  All  cases  cannot  be  cured.  Many 
are  subjects  for  the  specialist. 

The  TREATMENT  of  eye-diseases  is  necessarily  almost  en- 
tirely upon  the  neck,  as  it  has  been  shown  that  the  lesions  in 
these  cases  occur  here.  The  removal  of  the  these  various  lesions 
is  already  understood  from  discussions  in  the  previous  pages. 
The  treatment  looks,  in  general,  to  the  establishment  of  per- 
fect circulation,  and  the  regulation  of  the  nerve-mechanism. 
The  general  neck  treatment,  as  applied  in  cases  of  insomnia, 
headache,  apoplexy,  etc.,  q.  v.,  given  with  a  specific  object  in 
view,  would  be  the  method  employed  (see  also  Chap.  Ill  and  IV). 

In  many  cases  the  simple  removal  of  lesion  is  the  only  treat- 
ment required.  Often  this  treatment  and  the  general  neck  treat- 
ment may  be  supplemented  by  local  treatment  upon  the  eye, 
and  about  it,  reaching  its  nerve-mechanism  and  blood  circula- 
tion directly.  (See  Chap.  V,  A.  and  B)  This  work  includes 
treatment  to  the  fifth  nerve  as  the  one  being  in  charge  of  the  nutri- 
tion and  circulation  of  the  eye.  This  nerve  is  particularly  re- 
garded in  all  nutritive  diseases,  such  as  keratitis,  and  in  all  in- 
flammatory, hyperemic  or  anemic  conditions,  such  as  conjunc- 
tivitis, etc. 

In  conjunctivitis  the  local  irritant,  if  one  be  present,  must 
be  removed.  Treatment  should  not  be  made  upon  the  eye  in 
these  cases,  but  about  it.  The  chief  treatment  is  in  the  neck, 
especially  upon  the  superior  cervical  ganglion. 

In  granular  conjunctivitis  the  same  treatment  is  made. 
The  granulations  must  be  broken  down.  (Chap.  V).  After 
this  the  correction  of  the  circulation  by  the  cervical  treatment 
prevents  their  further  growth. 

In  keratitis  treatment  proceeds  as  in  conjunctivitis.  In 
both  conditions  the  fifth  nerve  must  be  especially  treated. 

The  removal  of  lesion  and  the  correction  of  blood-flow  are 
the  essential  points  in  these  and  all  similar  cases. 

"In  pterygium  especial  treatment  is  made  to  cut  off  the 
"feeders"  (V.  Chap.  V.)  After  this  operation  they  are  absorbed 
by  the  corrected  circulation  by  means  of  the  neck-work.  In 
some  cases  removal  of  neck  lesion  is  followed  by  absorption  of  the 


PRACTICE    OF    OSTEOPATHY.  339 

growth,  as  in  case  15.  Sometimes  light  manipulation  over  the 
closed  lids  aids  the  absorption. 

The  same  remarks  apply  to  pannus. 

In  diplopia,  ptosis,  strabismus,  and  other  motor  troubles, 
lesion  must  be  sought  as  the  cause  of  the  muscular  palsy,  tension, 
etc.  Treatment  is  applied  to  the  lesion  and  to  the  affected  nerve. 
These  troubles  sometimes  yield  to  the  correction  of  cervical  le- 
sion alone.  The  muscles  may  be  treated  directly  as  in  VI. 
Chap.  V. 

In  cataract  the  treatment  looks  to  the  absorption  of  the 
cataract  through  increased  circulation.  Cervical  treatment, 
removal  of  lesion,  and  local  treatment  about  the  eye  and  upon 
the  fifth  nerve,  all  as  before  described,  have  successfully  accomp- 
lished a  cure  in  these  cases.  In  such  cases,  Dr.  Still  says  that 
the  crystalline  lens  is  disarranged.  He  holds  one  fingerc  lose 
against  one  side  of  the  eye-ball,  with  the  lid  closed,  and  thumps 
this  finger  with  the  index  finger  of  the  other  hand,  to  jar  the  ball 
and  straighten  the  lens. 

In  the  various  optic  nerve  troubles,  also,  the  treatments 
"are  used  to  affect  the  nerve  through  its  blood-supply.  Nu- 
merous cases  of  blindness  from  optic-nerve  atrophy  have  been 
cured  in  this  way.  The  optic  nerve  be  may  stimulated  by  tap- 
ping or  pressure  upon  the  eye-ball.  (II,  III,  Chap.  V.)  Ret- 
initis  likewise  yields  to  this  treatment. 

In  conjugate  deviation,  both  eyes  turning  strongly  to  one 
or  other  side,  the  lesion,  usually  cervical,  affects  the  third  and 
sixth  nerves,  supplying  respectively  the  internal  rectus  and  the 
external  rectus  of  the  eye-ball.  The  treatment  is  local  and 
cervical. 


DISEASES  OF  THE  EAR. 

CASES:  (1)  Deafness  of  two  years  duration  in  a  lady  of 
forty-two,  caused  by  displacement  of  atlas  to  the  right,  tighten- 
ing muscles  and  ligaments  around  the  ear  and  lower  jaw.  Ten- 
derness was  extreme  in  the  cervical  region.  Dry  catarrh  was 
present.  There  was  lesion  of  the  2nd  cervical  vertebra.  The 
patient  had  been  injured  in  a  railroad  wreck,  being  confined  to 


240  PRACTICE    OF   OSTEOPATHY. 

bed.  She  could  not  hear  a  clock  strike  in  the  room,  nor  the 
playing  of  a  piano.  After  three  treatments  the  patient  could 
hear  the  clock  strike.  After  five  weeks  treatment  the  hearing 
was  completely  restored. 

(2)  Deafness   in   a  young    boy,  due  to  lesion  of  the   atlas. 
The  deafness  was  complete  in  one  ear,  and  almost  so  in  the  other. 
After  one  months  treatment  he  could  hear  conversation  spoken 
in  an  ordinary  tone. 

(3)  In  a  boy  of  fourteen,  a  continuous  discharge  from  the 
right  ear,  of  ten  years  standing.     Lesion  of  the  atlas  and  axis, 
luxated  to  the  right,  and  contraction  of  the  tissues.     The  case 
was  cured  in  nine  treatments. 

(4)  In  a  boy  of  eleven,  partial  deafness  in,  and  continual 
discharge  from,  one  ear.     The  lesion  was  a  slip  of  the  atlas. 
The  case  was  cured  in  one  months  treatment. 

(5)  In  a  young  lady,  an  abscess  in  one  ear  had  been  dis- 
charging for  several  months.     After  one  treatment  there  was  no 
further  discharge,   and   after  four  treatments  the   trouble  had 
disappeared. 

(6)  In  a  young  lady,  partial  deafness  of  some  years  stand- 
ing, continually  growing  worse.     Several  members  of  her  family 
are  afflicted  in  the  same  way.     An  ear  specialist  had  pronounced 
her  case  hopeless.     Lesions  were  luxation  of  the  2nd  and  3rd 
cervical  vertebrae;  thickened  tissues  at  the  base  of  the  skull; 
irregularity  of  the  upper  dorsal  vertebrae.     The  entire  treatment 
was  directed  to  the  head,  neck,  and  upper  dorsal  region,  with  the 
result  that  after  one  months  treatment  the  patient  could  hear  a 
watch  tick  at  double  the  distance  that  she  could  upon  beginning 
treatment. 

(7)  A  case  of  growing  deafness,  of  some  years  standing,  in 
a  gentleman  who  had  given  up  his  profession  upon  this  account. 
Lesion  was  found  at  the  atlas,  which  was  turned  backward  and 
to  the  left.     Upon  its  adjustment  the  hearing  was  much  im- 
proved. 

(8)  Complete  deafness  in  the  left  ear,  and  partial  deafi 

in  the  right  ear,  complicated  with  facial  neuralgia,  of  about  20 
years  standing.  The  atlas  was  posterior  and  to  the  left.  In 
two  months  treatment  great  improvement  was  made. 


PRACTICE    OF    OSTEOPATHY.  341 

(9)  A  case  of  intense  earache  of  years  standing.  The  atlas 
was  displaced  slightly  to  the  right.  This  was  adjusted  at  the 
first  treatment,  and  no  earache  appeared  after  that. 

The  LESION  in  ear  diseases,  as  illustrated  by  the  above  cases, 
is  almost  as  a  rule  in  the  atlas  and  axis.  The  3rd  cervical  and 
other  cervicals  may  be  affected,  but  in  the  vast  majority  of  cases 
the  atlas  and  axis,  one  or  both,  are  affected.  It  is  more  often 
at  the  atlas  than  elsewhere.  A  luxation  of  the  temporo-max- 
illary  articulation,  impinging  probably  the  articular  fibres  of  the 
auriculo-temporal  branch  of  the  inferior-maxillary  division  ^of 
the  fifth  nerve,  and  contractured  tissues  about  the  upper  cer- 
vical region  and  the  angle  of  the  jaw,  may  act  as  lesions  in  these 
diseases. 

The  fifth  nerve  supplies  the  external  auditory  canal  by  its 
auriculo-temporal  branches,  the  upper  one  of  which  sends  a 
branch  to  the  tympanum.  Also  the  vidian  of  the  fifth  sends 
nasal  branches  to  the  membranes  of  the  end  of  the  Eustachian 
tube.  The  internal  throat  treatment,  given  to  affect  this  tube, 
does  so  by  stimulating  these  fibres,  thus  freeing  the  secretions 
in  this  portion  of  the  Eustachian  tube.  Reasoning  by  analogy, 
doubtless  the  secretory,  trophic,  and  vaso-motor  functions  of 
the  fifth  nerve  with  relation  to  the  eye  and  other  parts  of  the  head 
•  and  face  are  extended  to  the  ear,  secretion  of  cerumen  and  cir- 
culation about  the  ear  being  to  some  extent  under  control  of  the 
fifth.  Experience  connects  lesions  of  this  nerve  with  ear-dis- 
eases. It  has  been  shown  that  the  nerve  suffers  from  lesion  of 
the  upper  cervical  region,  such  as  occur  in  ear-troubles  (see  Dis- 
eases of  the  Eye).  The  treatment  of  this  nerve,  so  important 
in  nasal  catarrh  and  other  inflammatory  affections  of  the  eye, 
nose,  and  parts  of  the  head,  is  important  likewise  in  these  catarrhal, 
inflammatory,  and  other  circulatory  troubles,  so  commonly  com- 
plicated with  the  diseases  of  the  ear. 

Vaso-constrictor  fibers  for  the  ear  are  contained  in  the  cer- 
vical sympathetic.  They  constitute  another  pathway  for  the 
effect  of  cervical  lesion  to  reach  the  ear.  Likewise  the  atlas  and 
axis  lesion  may  affect  the  blood-supply  of  the  ear  through  the 
iiH'd'ulla,  \vhich  suffers  from  these  lesions.  It  is  possible  that 
vaso-motors  for  the  head  exist  in  the  upper  dorsal  nerves,  though 


342  PRACTICE  OF  OSTEOPATHY. 

upper  dorsal  lesion  is  rare  in  ear  trouble.  It  is  likely  that  much 
of  the  effect  of  cervical  lesion  upon  the  ears  is  gotten  through 
the  vaso-motors  and  other  sympathetics. 

The  pneumogastric  nerve  has  an  auricular  branch,  and  is 
in  close  connection  with  the  fifth  in  relation  to  the  ear,  as  well 
as  with  the  cervical  sympathetic.  The  petrosal  ganglion  of  the 
glosso-pharyngeal  is  related  to  upper  cervical  lesion  by  sending 
a  branch  to  the  superior  cervical  ganglion.  Its  tympanic  branch 
passes  from  this  ganglion  and  contributes  fibers  to  the  mucous 
lining  of  the  middle  ear,  and  to  the  mastoid  cells.  It  sends 
branches  to  unite  with  the  sympathetic  and  form  a  plexus  on  the 
carotid  artery  in  the  carotid  canal.  Thus  is  this  nerve  connected 
both  with  neck  lesions  and  with  the  blood-supply  to  the  ear. 
The  facial  nerve,  well  known  to  be  influenced  by  lesions  of  the 
atlas  and  axis,  as  seen  in  facial  paralysis,  has  direct  communica- 
tion with  the  auditory  nerve  and  with  the  auricular  branch  of 
the  pneumogastric. 

The  various  simple  methods  described  in  the  texts  on  this 
subject  will  aid  one  to  determine  the  location  of  the  trouble  in 
the  external,  middle,  or  internal  ear.  The  disease  may  be  seated 
in  the  auditory  nerve  or  in  the  brain,  in  such  case  being  as  di- 
rectly connected  with  cervical  lesion,  before  shown  to  affect  the 
brain  and  cranial  nerves.  Examination  of  the  ear  is  given  in 
detail  in  Part  I. 

TREATMENT:  An  ear  syringe  may  be  used  in  the  ordinary 
ways  to  cleanse  the  ear  of  secretions,  discharges,  foreign  objects, 
insects,  etc.  Care  must  be  used  with  the  syringe.  It  should 
have  an  olivary  tip  to  prevent  introducing  it  so  far  as  to  touch 
the  drum.  If  a  piston  syringe  be  employed,  care  must  be  taken 
not  to  press  the  piston  in  too  quickly,  as  it  may  inject  the  fluid 
with  sufficient  force  to  injure  or  perforate  the  drum.  It  is  best 
to  use  an  ordinary  fountain  syringe,  with  an  appropriate  tip. 
and  hung  up  not  more  than  a  foot  or  eighteen  inches  above  the 
level  of  the  patient's  head,  in  order  to  have  a  gentle  flow. 

For  antisepsis,  to  insure  cleanliness  when  there  are  discharges 
from  the  ear,  one  may  use  a  warm  solution  of  boracic  acid,  sat- 
urated, or  containing  from  one  to  two  teaspoonfulls  of  the  powder 
to  a  pint  of  water. 


PRACTICE    OF    OSTEOPATHY.  343 

When  there  is  a  firm  plug  of  cerumen  in  the  canal,  it  is  well 
to  first  soften  it  by  dropping  a  few  drops  of  sweet  oil  into  the 
canal,  and  allowing  it  to  remain  over  night  after  having  plugged 
the  meatus  with  a  little  absorbent  cotton.  After  the  softening 
process,  a  good  deal  of  the  wax  may  be  carefully  removed  with 
a  spatula,  but  it  is  not  always  advisable  to  attempt  to  remove  it 
all  in  this  way,  as  the  canal  may  be  sensitive  or  the  drum  may  be 
irritated.  The  remnants  may  always  be  safely  and  easily  re- 
moved by  gentle  syringing.  Considerable  water  may  be  used  if 
necessary. 

When  insects  get  into  the  ear  they  should  be  first  drowned 
with  a  little  water  or  sweet-oil,  then  removed  by  syringing. 

The  removal  of  bony  lesion  and  the  cervical  treatment  as 
before  described  are  the  main  osteopathic  treatments  applied 
in  ear  diseases.  The  presence  of  the  original  cause  of  these  dis- 
eases in  the  form  of  neck  lesion  necessitates  practically  the  whole 
treatment  being  cervical.  There  is  no  local  ear  treatment,  ex- 
cept as  in  common  methods  in  vogue  in  use  of  syringe,  etc. 

Outside  of  removal  of  lesion,  an  almost  specific  treatment 
for  eye  and  ear  is  that  of  opening  the  mouth  against  resistance 
(Chap.  IV,  Div.  I,  II,  VII),  and  the  neck  treatment,  with  the 
object  of  increasing  circulation  through  the  carotid  arteries. 
Due  attention  is  given  to  the  cervical  sympathetics  and  vaso- 
motors  in  this  connection. 

A  valuable  local  treatment  of  the  ear  in  cases  where  the 
drum,  or  local  circulation,  or  normal  secretions,  etc.,  are  affected, 
is  as  follows: 

The  tragus  is  pressed  rather  firmly  into  the  external  meatus, 
and  then  quickly  released,  the  operation  being  repeated  about 
once  per  second.  Or  the  finger  may  be  moistened  and  introduced 
into  the  meatus,  being  worked  in  and  out  like  a  piston".  These 
treatments  create  a  local  suction  and  pressure  which  stimulates 
circulation  and  all  the  local  tissues,  stretches  and  massages  the 
•  drum,  and  helps  to  soften  and  relax  it  in  cases  of  retraction  due 
to  catarrhal  processes,  etc.  In  cases  of  retraction  of  the  drum 
it  is  sometimes  helpful  to  frequently  introduce  a  little  sweet 
oil-  into  the  canal  to  aid  in  softening  it.  Such  treatments  also 
aid  in  loosening  the  ossicles  in  catarrhal  deafness,  thus  rendering 


344  PRACTICE  OF  OSTEOPATHY. 

them  more  susceptible  to  vibrations  of  sound.  These  treatments 
will  materially  aid  in  improving  the  hearing  in  some  cases. 

A  similar  effect  is  gotten,  also,  by  inflating  the  ear  drum  in 
the  familar  manner  of  holding  nostrils  and  mouth  closed  and 
blowing.  This  should  be  judiciously  practiced  by  the  patient 
in  all  cases  of  retraction  of  the  drum  in  catarrhal  deafness,  in  order 
to  keep  the  drum  and  ossicles  relaxed  and  able  to  vibrate,  but  this 
must  not  be  done  to  excess  for  fear  of  eventually  leading  to  hyper- 
trophy of  the  drum.  A  few  inflations,  once  or  twice  per  day,  are 
enough. 

The  drum  may  also  be  inflated  by  the  practitioner,  who 
spreads  a  clean  handkerchief  over  the  ear  and  applies  his  lips 
close  over  the  meatus  and  blows.  It  is  probable  that  by  these 
means,  and  more  especially  by  the  latter,  subluxations  of  the 
ossicles  may  be  reduced,  restoring  or  aiding  the  hearing.  There 
are  on  record  some  cases  in  which  a  few  such  inflations  have 
greatly  increased  the  power  of  hearing,  probably  because  thereby 
luxated  ossicles  have  been  articulated. 

The  throbbing,  buzzing  or  humming  sounds  that  occur  in 
the  ear  with  catarrha"!  affections,  etc.,  can  sometimes  be  stopped 
by  use  of  the  above  measures. 

Perforations  of  the  drum  generally  readily  heal  up,  as  do 
incisions  by  the  knife,  but  not  always.  These  perforations  may 
not  be  in*  the  drum  proper,  but  at  the  notch  of  Rivinius,  which 
is  covered  with  skin  and  will  quickly  heal. 

The  internal  throat  treatment  may  be  used,  the  finger  be- 
ing directed  about  the  opening  of  the  Eustachian  tube  to  stim- 
ulate the  local  points  of  the  fifth  nerve,  the  mucous  membranes, 
and  thus  the  secretions.  This  aids  in  freeing  the  tube,  an  ob- 
ject that  is  well  accomplished  by  the  aid  of  the  external  throat 
treatment  upon  the  carotids,  etc. 

In  catarrhal  affections  of  the  ear  the  treatment  is  as  described 
for  nasal  catarrh. 

In  earache  the  treatment  embraces  the  repair  of  lesion, 
inhibition  of  the  upper  cervical  nerves,  and  inhibition  about  the 
mastoid  process,  below  the  ear,  in  front  of  the  ear,  etc. 


PRACTICE    OF    OSTEOPATHY.  345 

DISEASES  OF  THE  BLOOD  AND  DUCTLESS  GLANDS. 

GOITRE;  EXOPHTHALMIC  GOITRE. 

CASES:  (1)  In  a  lady  of  twenty-five,  a  bilateral,  vascular  goitre 
of  about  three  months  standing,  growing  rapidly,  causing  con- 
siderable dyspnea  and  discomfort.  The  treatment  consisted 
merely  of  stretching  the  muscles  and  ligaments  attached  to  the 
sternal  end  of  the  clavicle,  raising  it,  and  depressing  the  first  rib. 
Marked  improvement  followed  the  treatment  at  once.  Two 
months  later  the  enlargement  and  .other  symptoms  had  disap- 
peared. 

(2)  Exophthalmic   goitre   and   nervous   prostration   of   one 
months  standing.     The  trouble  followed  nervous  strain  and  over- 
work.    The  goitre  was  as  large  as  a  hen's  egg,  and  the  usual 
symptoms  of  exophthalmic  goitre  were  present.     The  case  yielded 
rapidly  to  treatment  and  at  the  end  of  two  weeks  the  goitre  had 
disappeared  and  the  eyes  were  normal.     In  one  month  the  patient 
had  recovered  from  the  goitre  and  nervous  prostration,  and  had 
gained  twenty  pounds  in  weight. 

(3)  In  a  boy  of  fourteen,  a  goitre  of  two  years  standing. 
Lesion  existed  as  lowering  of  the  right  clavicle  and  muscular 
contracture  in  the  lower  cervical  and  upper  dorsal  region.     One 
treatment  a  week  for  twelve  weeks  cured  the  case. 

(4)  A  case  of  goitre  treated  by  raising  the  clavicles,  relax- 
ing the  tissues  surrounding  the  gland.     After  one  month  there 
was  a  perceptible  change,  after  two  months  the  growth  had  begun 
to  get  smaller  and  after  three  months  the  condition  was  cured. 

(5)  In  a  lady  of  thirty-four,  a  large  exophthalmic  goitre 
with  all  the  usual  symptoms  marked.     The'  general  system  was 
in  bad  condition.     Lesion  was  luxation  of  the  fourth  cervical 
vertebra;  the  spine  was  irregular.     The  case  was  cured  in  six 
months. 

(6)  In  a  lady,  a  goitre  of  one  years  standing.     No  bony 
lesions  were  found.     After  one  months  treatment  the  diameter 
of  the  neck  had  been  decreased  one  and  one-half  inches. 

(7)  Exophthalmic   goitre    of   eight    months   standing    in    a 
woman   of   26.     Lesions   were:  3rd   and   4th   cervical   vertebrae 
posterior,  7th  cervical  lateral  to  the  left;  3rd,  4th  and  5th  dorsal 


346  PRACTICE    OF    OSTEOPATHY. 

posterior;  subluxation  of  4th  rib  on  the  left  side.  Benefit  was 
noted  after  the  2nd  treatment,  and  the  case  was  cured  in  four 
months. 

(8)  Dr.  Still  mentions  a  case  of  vassular  goitre  in  which  he 
raised  the  clavicles  and  caused  the  goitre  to  entirely  drain  away 
in  45  minutes. 

DEFINITION:  Goitre  is  denned  as  "chronic  hypertrophy 
or  hyperplasia  of  a  portion  or  the  whole  of  the  thyroid  gland. 
It  is  of  obscure  origin,  involving  one  or  more  of  the  structural 
tissues,  and  is  subject  to  various  degenerative  changes." 

The  so-called  simple  goitre  is  met  in  various  forms:  simple 
hypertrophic,  follicular,  fibrous,  vascular,  cystic,  degenerative, 
etc.  The}-  are  frequently  met  and  treated  osteopathically. 

Exophthalmic  goitre  (Graves'  or  Basedow's  disease)  is  quite 
a  different  condition.  It  is  defined  as,  "a  chronic  neurasthenic 
neurosis  characterized  by  rapid  heart-beat,  enlarged  thyroid. 
protrusion  of  the  eye-balls,  and  various  neurasthenic  or  vas<>- 
motor  symptoms." 

Osteopathy  simply  regards  goitre  as  an  enlargement  of 
the  thyroid  gland  due  to  a  specific,  usually  bony,  lesion  which 
interferes  with  the  proper  blood  and  lymph  circulation  of  that 
body.  This  leads  to  congestion,  engorgement,  and  hypertrophy. 
In  some  cases,  especially  in  exophthalmic  goitre,  the  lesion  may 
act  chiefly  upon  the  innervation  of  the  gland,  producing  the 
various  phenomena  marking  the  disease. 

The  LESIONS  bear,  in  conformity  with  the  above  view,  a 
close  anatomical  relation  to  the  disease.  They  are  generally 
bony  lesions  of  the  cervical  and  upper  thoracic  regions,  consist-' 
ing  in  displacements  of  middle  and  lower  cervical  vertebrae,  of 
the  clavicle,  or  of  the  first  rib.  Yet  various  muscular,  and  other 
tissue,  contractures  are  often  found  as  the  lesions  in  the  case. 
These  commonly  occur  together  with  bony  lesion,  but  may  be 
independent  of  such.  They  occur  mostly  in  the  anterior  region 
of  the  neck,  involving  the  infra-hyoid  muscles  and  the  soft  tissues 
down  to  the  root  of  the  neck.  The  scaleni  muscles  are  often  in- 
volved. The  posterior  cervical  and  upper  dorsal  muscles  are 
sometimes  found  contractured  and  acting  as  lesion. 

The  chief  bony  lesions  in  simple  goitre  are  of  the  clavicle 


PRACTICE    OF    OSTEOPATHY'.  347 

and  first  rib,  while  in  exophthalmic  goitre  lesions  of  the  cervical 
vertebrae  are  more  frequent.  Dr.  Still  points  out  that  in  goitre 
the  heads  of  the  first  ribs  will  often  be  found  to  be  displaced  up- 
ward and  outward,  away  from  the  spinal  column.  Yet  either 
form  of  lesion  may  occur  in  either  case.  The  clavicle  and  rib 
lesion,  and  the  contracturing  of  the  anterior  cervical  tissues  act 
specifically  by  obstructing  arterial,  venous,  and  lymphatic  cur- 
rents to  and  from  the  gland.  The  inferior  thyroid  artery  arises 
from  the  thyroid  axis,  which,  lying  behind  the  clavicle  and 
scalenus  anticus  muscle  may  suffer  pressure  from  them  when 
abnormal  in  position.  The  superior  thyroid  artery  is  related  to 
the  infra-hyoid  muscles,  and  may  suffer  from  their  contracture. 
But  the  interferences  of  these  lesions  with  the  lymphatic  and 
venous  drainage  of  the  gland  are  doubtless  most  potent  in  causing 
goitre.  The  lymphatics  of  the  gland  are  large  and  numerous, 
emptying  upon  the  right  into  the  lymphatic  duct,  upon  the  left 
into  the  thoracic  duct,  both  avenues  of  lymphatic  drainage, 
therefore,  lying  where  derangement  of  clavicle  or  of  first  rib  may 
obstruct  them. 

Just  as  clavicular  and  first  rib  lesion  has  been  known  to 
obstruct  lymphatic  drainage  of  the  breast  and  result  in  so-called 
cancer,  the  same  kind  of  lesion  may  prevent  lymphatic  drainage 
and  cause  goitrous  enlargement  of  the  thyroid. 

In  a  like  manner  the  venous  return  becomes  abridged. 
The  superior  and  middle  thyroid  veins  are  in  relation  to  the  in- 
ferior hyoid  muscles,  and  suffer  pressure  from  their  contracture. 
They  both  empty  into  the  internal  jugular  vein  which  may  be 
obstructed  by  clavicular  lesion.  The  chief  venous  flow  is  through 
the  three  or  four  large  inferior  thyroid  veins,  and  it  may  be  im- 
pinged by  clavicular  and  anterior  cervical  lesion.  This  view  of 
lesion  is  well  supported  by  the  fact  that  simple  goitres  often 
rapidly  disappear,  after  treatment  restoring  clavicle  and  first 
rib  to  position,  relaxing  anterior  cervical  tissues,  and  re-estab- 
lishing perfect  circulation  of  all  fluids  to  and  from  the  thyroid. 
This  has  been  observed  in  some  cases,  probably  of  vascular  goitre, 
by  Dr.  Still,  in  which  the  facts  strikingly  illustrate  the  correctness 
of  the  osteopathic  etiology.  In  these  cases  he  saw,  in  a  fewr  hours, 
a  great  reduction  in  the  volume  of  the  gland  follow  removal  of 


348  PRACTICE    OF    OSTEOPATHY. 

such  obstructions  to  the  vessels.  The  glands  seemed  to  have 
been  rapidly  emptied  and  the  goitre  drained  away  by  the  re- 
newed drainage. 

The  nerve-supply  of  the  thyroid  gland  is  from  the  middle 
and  inferior  cervical  ganglia  of  the  sympathetic.  Consequently 
various  vertebral  lesions  are  found,  especially  in  exophthalmic 
goitre.  Such  lesions  have  been  found  from  the  2nd  to  the  7th 
cervical  vertebra.  In  discussing  diseases  of  the  eye  and  of  the 
heart,  the  connections  of  the  cervical  sympathetic  mechanism 
with  both  of  these  organs  has  been  pointed  out.  The  lesions  oc- 
curring thus  to  the  innervation  of  the  thyroid,  cervical  lesions, 
are  likewise  closely  related  anatomically  to  the  innervation  of 
eye  and  heart,  accounting  in  part  for  the  related  disturbance  of 
these  organs  in  exophthalmic  goitre. 

This  disease  has  been  regarded  by  medical  writers  as  due 
to  disturbed  innervation  of  the  gland,  or  to  an  affection  of  the 
sympathetic  nerves.  It  has  been  sometimes  thought  that  the 
seat  of  the  disease  is  in  the  medulla,  and  that  the  disturbance  of 
the  thyroid  function  causes  the  gland  to  throw  into  the  blood 
substances  that  irritate  the  nerves  and  cause  the  various  neuras- 
thenic symptoms  accompanying  the  condition.  It  is  readily  seen 
that  cervical  lesion  may  disturb  the  innervation  of  the  organ, 
set  up  the  sympathetic  disturbance,  and  derange  the  function 
of  the  thyroid.  This  disturbance  of  the  sympathetic  innervation 
is  further  evident  in  the  vascular  condition  of  the  gland,  its 
arteries  being  dilated,  and  in  the  paralysis  of  the  orbital  vessels, 
whicll  become  distended  with  blood  and  cause  the  exophthalmos. 
Dana  explains  all  symptoms  upon  the  theory  of  vaso-motor  and 
cardio-motor  paresis,  a  result  that  may  readily  be  due  to  the 
operation  of  cervical  lesion  upon  the  sympathetic. 

The  PROGNOSIS  is  good  in  all  cases.  It  is  to  be  noted  that 
according  to  Anders  the  prognosis  in  goitre  (simple)  is  but  guard- 
edly favorable  as  to  life,  but  unfavorable  as  to  cure,  while  but 
few  cases  of  exophthalmic  goitre  are  expected  to  be  cured.  Yet 
under  osteopathic  treatment  very  numerous  cases  of  both  kinds 
have  been  cured.  A  cure  is  often  effected,  even  in  long  standing 
cases  which  have  tried  all  the  known  remedies. 

The   prognosis   is   most   favorable   in   younger   and   shorter 


PRACTICE    OF    OSTEOPATHY.  349 

cases,  and  in  those  in  which  the  gland  is  soft.  Under  treatment, 
signs  of  softening  in  a  part  of  the  gland  are  indications  of  pro- 
gress. In  the  vascular  and  parenchymatous  forms  the  progress 
is  good.  The  former  promise  the  most  for  quick  results.  In 
the  hard,  fibrous  forms,  and  in  those  in  which  degeneration  of  the 
tissues,  or  calcareous  infiltration  has  taken  place,  the  prognosis 
is  not  favorable. 

Some  cases  of  goitre  yield  quickly;  some  are  very  slow. 
From  one  to  three  months  treatment,  or  much  longer,  is  usually 
necessary. 

The  TREATMENT  looks  at  once  to  the  removal  of  lesion, 
and  to  the  free  opening  of  lymphatic  and  venous  drainage.  All 
the  cervical  muscles  must  be  relaxed.  This  direction  applies 
to  the  deep  anterior  cervical  and  the  hyoid  muscles,  as  well  as 
to  the  tissues  about  the  gland. 

Pressure  is  made  downward  over  the  goitre,  out  about  its 
edges,  and  along  the  course  of  the  veins  draining  it.  All  the 
tissues  about  the  root  of  the  neck  anteriorly,  and  about  clavicles 
and  first  ribs,  must  be  relaxed.  The  ribs  and  clavicles  should 
be  separated,  elevating  the  latter  and  depressing  the  former. 

Close  attention  should  be  given  to  all  the  cervical  verte- 
bral articulations,  seeing  that  they  are  perfectly  adjusted. 

In  exophthalmic  goitre  one  must  look  particularly  to  the 
cervical  sympathetics,  toning  them  to  overcome  the  vaso-motor 
paresis.  Inhibitory  cardiac  and  local  eye  treatment  may  be 
applied  as  before  directed.  A  moderate  pressure  of  the  eye-ball 
back  into  its  orbit  -aids  in  emptying  the  blood  from  the  distended 
vessels.  For  a  similar  reason  pressure  upon  the  gland,  in  ex- 
ophthalmic and  in  vascular  forms  of  goitre,  is  good  measure.  In 
the  former  kind  one  should  look  well  to  the  constitutional  condit- 
ion and  to  that  of  the  general  nervous  system. 

ANEMIA. 

DEFINITION:  A  condition  in  which  there  is  a  diminution 
either  in  the  quantity  of  blood  or  in  one  of  its  constituents. 

The  Anemias  are  divided  into:  I.  Primary  (simple,  chloro- 
tic,  and  pernicious) ;  II.  Secondary  (symptomatic) ;  III.  Leu- 
cocytosis;  IV.  Leucocythemia. 


PRACTICE    OF    OSTEOPATHY. 

The  lesions  noted  in  anemia  are  merely  of  the  general  spinal 
form.  Cases  of  primary  and  secondary  anemia  come,  with  fair 
frequency,  under  our  treatment.  They  are  almost  without  ex- 
ception successfully  treated. 

The  TREATMENT  in  all  the  anemias  is  practically  the  same, 
varying  in  different  cases  according  to  the  manifestations  and 
needs  of  the  case.  In  all  forms  the  general  plan  of  treatment 
is  to  remove  such  lesions  as  may  be  found  present  and  to  give 
special  attention  to  the  renovation  of  the  general  health  by 
thorough  general  spinal  treatments,  designed  to  increase  heart- 
action,  tone  the  circulation,  increase  nutrition,  and  thus  to  im- 
prove the  quality  of  the  blood. 

In  SIMPLE  OR  BENIGN  ANEMIA  (Primary),  the  treatment 
embraces  removal  of  lesion  and  the  thorough  general  treatment 
above  described.  Special  treatment  should  be  given  the  spleen. 
The  liver,  kidneys,  skin  and  bowels  should  be  kept  active.  In 
this  way  the  quality  of  the  blood  is  improved,  and  nutrition  of 
the  tissues  is  increased. 

The  heart  should  be  kept  well  stimulated  in  order  to  over- 
come palpitation.  This  treatment  also  aids  in  overcoming  the 
dyspnea,  which  should  be  further  treated  by  lower  costal  treat- 
ment to  stimulate  the  diaphragm  and  by  raising  the  ribs  and 
stimulating  the  lung  area  of  the  spine  (2nd  to  7th  dorsal) .  Head- 
a,che  should  be  treated  in  the  usual  way.  It  is  quite  necessary 
to  look  after  the  hygienic  conditions  under  which  the  patient 
lives.  Diet,  drink,  and  manner  of  life  need  attention. 

In  CHLOROSIS  or  "green  sickness"  one  must  follow  the  general 
plan  of  treatment  outlined  above.  This  condition  is  character- 
ized especially  by  a  deficiency  of  hemoglobin  in  the  red  corpuscles, 
and  iron  is  the  specific  drug  remedy  employed.  There  is  a  ques- 
tion whether  the  iron  thus  administered  is  absorbed  by  the  blood. 
The  osteopathic  idea  is  to  normalize  the  organic  functions  of  the 
body  and  to  build  good  blood  by  increasing  glandular  activity 
in  the  body.  This  excretes  impurities  and  enables  the  blood  to 
secure  from  the  food  the  elements,  especially  iron,  that  are  lack- 
ing in  it. 

The  heart  must  be  kept  well  stimulated,  as  the  cardiac  mus- 
cle is  often  softened,  and  the  organ  may  be  dilated.  Special 


PRACTICE    OF    OSTEOPATHY.  351 

attention  must  be  given  to  disorders  of  menstruation.  The  dis- 
ease often  dates  from  a  period  of  scanty  menstruation,  and  while 
amenorrhoea  is  said  not  to  be  a  cause  of  the  condition,  it  is  quite 
necessary  to  overcome  it,  if  present,  in  the  process  of  restoring 
health. 

The  treatment  must  also  be  directed  to  a  regulation  of  the 
bowels,  as  toxemia  due  to  the  absorption  of  poison  from  retained 
fecal  matter  has  much  to  do  in  causing  chlorosis,  it  is  held  by  some. 

Attention  should  be  given  to  hygienic  conditions.  Pure 
air,  plenty  of  nutritious  food,  good  sleep,  etc.,  are  necessary. 
Moderate  exercise  and  hot  baths  are  recommended. 

Nervous,  circulatory,  gastro-intestinal,  and  general  symp- 
toms may  be  met  according  to  the  needs  of  the  case. 

PROGRESSIVE  PERNICIOUS  ANEMIA  requires  much  care  in 
treatment,  as  it  is  considered  a  dangerous  condition.  However, 
under  osteopathic  treatment  it  seems  to  be  readily  cured.  A 
thorough  general  spinal,  muscular  and  abdominal  treatment  is 
necessary  to  overcome  the  anemic  condition  of  most  of  the  or- 
gans and  tissues.  The  general  treatment  above  described  should 
be  assiduously  applied.  In  the  course  of  it  heart,  liver,  kidneys, 
and  gastro-intestinal  tract  should  be  well  treated,  as  they  show  a 
tendency  to  fatty  degeneration.  Increase  of  general  circulation 
overcomes  the  tendency  to  ecchymosis  in  skin  and  mucous  mem- 
branes. 

Particular  attention  must  be  given  to  the  spinal  treatment, 
spinal  circulation  should  be  kept  active  to  guard  against  sclerosis 
of  the  posterior  and  lateral  colums  of  the  cord,  to  which  are  due 
the  various  paralytic  symptoms  which  are  likely  to  occur. 

SECONDARY  ANEMIAS  are  purely  symptomatic.  They  in- 
dicate some  disease  or  abnormal  process  in  the  body,  and  may 
at  the  same  time  be  complicated  with  one  of  the  primary  anemias. 
They  occur;  (1)  after  hemorrhage,  as  from  bursting  of  an  aneurysm 
epistaxis,  piles,  menorrhagia,  etc. ;  (2)  in  inanition,  as  from  esoph- 
ageal  carcinoma,  chronic  gastritis,  etc.;  (3)  from  excessive 
a  I  hum  in  ions  discharges,  as  in  B  right's  disease,  lactation,  exten- 
sive suppuration,  dysentery,  etc.;  (4)  from  the  action  of  toxic 
agents,  as  in  poisoning  from  lead,  mercury,  arsenic,  phosphorus, 
or  in  acute  or  chronic  infectious  diseases. 


352  PRACTICE    OF    OSTEOPATHY. 

The  prognosis  depends  upon  that  for  the  primary  condition. 

The  TREATMENT  must  be  according  to  the  cause.  After 
hemorrhage,  rest  and  nutritious  diet  are  required.  The  primary 
disease  in  each  case  must  be  treated.  Hygienic  treatment,  plenty 
of  fresh  air,  good  food,  sunshine,  rest,  and  later,  light  exercise, 
necessary.  In  toxic  cases  the  excretories  must  be  kept  stimu- 
lated to  eliminate  the  poisons  from  the  system. 

LEUCOCYTOSIS  is  "a  temporary  increase  in  the  number  of 
polymorphoneuclear  leucocytes  in  the  blood,  though  rarely  in 
the  mononeuclear  elements."  It  may  be  continuous. 

It  is  often  a  physiologic  condition,  as  soon  after  birth,  during 
pregnancy,  after  meals,  after  exercise,  after  massage  and  baths, 
etc. 

It  is  frequently  a  pathologic  condition,  being  secondary  to 
disease,  as  acute  inflammations  and  acute  infectious  febrile  dis- 
eases. 

Being  reparative  and  protective  in  nature,  a  natural  pro- 
cess, it  calls  for  no  treatment.  Treatment  should  be  directed 
to  the  primary  disease. 

LEUCOCYTHE.MIA,  or  leukemia,  is  a  blood  disease  in  which 
there  is  marked  and  persistent  increase  of  the  number  of  leu- 
cocytes in  the  blood.  It  is  said  to  be  due  to  lesion  to  the  spleen, 
bone-marrow,  and  lymphatic  glands.  The  spleen  and  lymphatic 
glands  are  enlarged. 

The  prognosis  is  not  favorable. 

The  TREATMENT  should  be  upon  the  general  lines  before 
laid  down.  The  gastro-intestinal  symptoms;  shortness  of  breath; 
edema  of  ankles,  face  and  hands,  etc.,  occur  as  in  the  anemias. 
Treatment  should  include  the  liver,  which  is  found  to  be  enlarged, 
and  the  kidneys  should  be  kept  stimulated,  as  the  leucocytes 
collect  in  them,  as  in  the  liver. 

MYXEDEMA. 

This  is  a  condition  in  which  there  is  a  peculiar  disorder  rf 
the  general  nutrition  of  the  system,  due  to  atrophy  and  loss  of 
function  of  the  thyroid  gland.  There  is  a  myxomatous  change 
of  the  sub-cutaneous  tissues,  and  a  cretinoid  cachexia. 


PRACTICE    OF    OSTEOPATHY.  353 

The  condition  appears  as,  (1)  True  Myxedema,  (2)  Spo- 
radic Cretinism,  or  (3)  Operative  Myxedema. 

But  few  cases  have  been  treated  Osteopathically.  Re- 
sults are  not  satisfactory.  McConnell  states  that  serious  lesions 
of  the  cervical  vertebrae  have  been  found  in  these  cases. 

The  TREATMENT  must  necessarily  be  a  general  one  to  in- 
crease general  nutrition,  and  to  thus  aid  in  overcoming  the  con- 
dition of  malnutrition  of  the  system.  The  disease  is  regarded 
as  being  of  tropho-neurotic  origin.  It  is  supposed  that  the  in- 
ternal secretion  of  the  active  thyroid  gland  aids  in  maintaining 
the  normal  metabolism  of  the  body,  consequently  it  is  of  great 
importance  in  these  cases  to  remove  lesion  to  the  gland,  restore 
nerve  and  blood-supply  to  it,  arid  thus  regenerate  its  activities. 

In  case  of  congenital  absence  or  removal  of  the  gland  it  is 
obvious  that  nothing  could  be  done  except  to  maintain  the  gen- 
eral health  by  the  treatment,  and  overcome  in  that  way,  if  pos- 
sible, the  effects  of  the  lack  of  thyroidin.  It  seems  that  in  these 
cases  thyroid  feeding,  a  treatment  regarded  as  specific,  would  be 
necessary. 

In  case  of  atrophy  of  the  gland  an  attempt  should  be  made 
to  upbuild  it  by  local  work  on  circulation  and  nerve-supply. 
Cervical  treatment  should  be  added,  to  increase  circulation  to 
the  brain,  and  the  kidneys  should  be  kept  active  to  overcome  the 
tendency  for  sugar  and  albumin  to  appear  in  the  urine. 

The  local  treatment  should  be  upon  and  about  the  gland, 
coupled  with  a  cervical  and  upper  thoracic  treatment,  as  de- 
scribed for  goitre,  q.  v. 

CONSTITUTIONAL  DISEASES. 

RHEUMATISM. 

CASES:  (1)  *Inflammatory  rheumatism,  off  and  on,  for 
sixteen  years.  The  effect  was  general,  but  the  body  below 
the  waist  was  worse,  hip  and  lower  limbs  being  very  bad.  Le- 
sion occurred  at  the  4th  lumbar  vertebra.  The  inflammation 
began  to  subside  with  the  first  treatment.  The  patient,  con- 
fined to  the  bed,  was  able  to  sit  up  in  one  week,  and  was  cured. 

*-For  convenience  Acute  Rheumatic  Fever  is  considered  here  instead  of  with  the 
Infectious  Diseases. 
23 


354  PRACTICE    OF    OSTEOPATHY. 

(2)  Muscular  rheumatism,  in  the  form  of  torticollis,  follow- 
ing malarial  fever.     The  condition  was  of  one  months  standing. 
It  improved  from  the  first  treatment,  and  was  cured  in  three 
weeks. 

(3)  Muscular  rheumatism  in  the  shoulder,  the  patient  hav- 
ing been  unable  to  raise  her  hand  to  her  head  for  seven  months. 
The  first  rib  was  found  partly  dislocated  at  its  head.     The  arm 
could  be  raised  to  the  head  after  one  treatment,  and  the  case 
was  cured  in  one  month. 

(4)  Acute  articular  rheumatism  in  a  lady  of  eighty-three, 
of  three  months  standing.     Lesions  occurred  in  the  upper  dorsal 
and  lumbar  regions  of  the  spine.     The  hips  and  khees  were  af- 
fected.    One  months  treatment  had  greatly  improved  the  case. 

(5)  Articular  rheumatism   affecting  the  foot,   of  six  years 
standing,  and  due  to  an  upward  dislocation  of  the  tarsal  end  of 
the  first  metatarsal  bone.     The  case  was  cured  by  reducing  the 
dislocation. 

(6)  Chronic    rheumatism    of    eight    months   standing.     The 
patient  was  unable  to  raise  his  hand  to  his  head  or  to  dress  him- 
self.    After  one  treatment  he  could  do  both,  and  the  case  was 
practically  cured  by  four  treatments.     Lesions  were  found  at 
the  third  cervical  vertebra,  1st  to  4th  dorsal,  and  4th  lumbar. 

(7)  Lumbago,  in  occasional  attacks,  one  of  which  had  been 
brought  on  by  bicycling.     Lesion  was  found  in  a  lateral  luxa- 
tion of  the  4th  lumbar  vertebra.     The  case  was  relieved  by  one 
treatment,  and  was  cured  in  three  treatments. 

(8)  Lumbago,   brought   on   by   a   muscular  strain,   showed 
lesions  at  the  lumbo-sacral   and   sacro-iliac  articulations.     The 
ease  was  cured  in  a  few  treatments. 

LESIONS:  In  the  three  forms,  Acute  Articular  Rheuma- 
tism, or  Rheumatic  Fever,  or  Inflammatory  RehumatismjChronic, 
or  Chronic  Articular  Rheumatism;  and  Muscular  Rheumatism, 
various  bony  and  muscular  lesions  are  found.  In  rheumatic 
fever  special  bony  lesions  may  be  lacking.  Often  spinal  le- 
sions affecting  liver  and  kidneys  are  found,  and  muscular 
contractures  may  be  present' as  lesion.  Bony  lesions  are  apt 
to  occur  at  the  origin  of  the  nerves  supplying  the  affected  points. 
Contractured  tissues  due  to  climatic  effects  are  common. 


PRACTICE    OF    OSTEOPATHY. 

In  practically  all  forms  of  rheumatism,  lithsemia,  uric  acid, 
gout,  and  the  allied  conditions,  the  real  foundation  of  the 
trouble  lies  in  lesions  which  interfere  with  metabolism.  The 
commonest  of  these  are  found  in  the  splanchnic  area  of  the 
spine,  interfering  chiefly  with  the  functions  of  the  digestive 
tract  and  of  the  liver.  Probably  the  great  majority  of  these 
cases  originate  in  this  way.'  Often  some  other  particular  lesion 
determines  the  point  at  which  the  disease  makes  its  chief  at- 
tack. 

In  Muscular  and  Chronic  Rheumatism  specific  lesion  is 
much  more  definite  than  in  Rheumatic  Fever.  Local  bony  le- 
sions play  an  important  part  in  the  production  of  muscular  rheu- 
matism, as  do  also  muscular  contractures.  Both  may  be  due 
to  physical  strains.  Contractures  may  likewise  be  due  to  ex- 
posure to  inclement  weather,  etc. 

It  is  common  in  muscular  rheumatism  of  shoulders  and 
arms  to  find  luxation  of  the  lower  cervical  and  upper  dorsal 
vertebrae,  one  or  several,  together  with  contractures  in  the  fibres 
of  the  trapezius  muscles  in  these  regions.  So  in  rheumatism  of 
special  muscle  groups,  bony  lesion  is  quite  generally  found  at 
the  origin  of  the  nerves  supplying  them.  This  is  equally  true 
for  chronic  articular  rheumatism.  For  example,  in  those  very 
numerous  cases  in  which  the  joints  of- the  lower  limbs  are  affected, 
it  is  almost  the  rule  to  find  lumbar  or  innominate  lesions  obstruct- 
ing the  nerve-supply  to  the  limbs. 

In  rheumatic  affections  .of  special  localities  as,  for  ex- 
ample, the  wrist,  ankle,  etc.,  it  is  common  to  find  a  local  bony 
part  out  of  place,  as  carpal,  tarsal,  or  metatarsal  bone.  In  lum- 
bago there  is  almost  invariably  luxation  of  lumbar  vertebrae, 
irritating  the  nerve-fibres  supplying  the  muscle-bundles  of  the 
erectors  spinae. 

The  contracturing  of  tissues  as  the  result  of  chronic  rheu- 
matism is  often  sufficient  to  draw  a  joint  out  of  place,  as  in  case 
of  the  hip- joint. 

Lesions  in  rheumatism  act  by  deranging  blood  and  nerve- 
supply,  locally  or  generally.  In  inflammatory  rheumatism  the 
effect  is  a  constitutional  one,  acting  upon  the  system  through 
lesions  which  derange  the  functions  of  liver  and  kidneys;  also 


356  PRACTICE   OF   OSTEOPATHY. 

of  the  central  nervous  system.  Yet  this  condition  is  often  a 
good  deal  like  "catching  cold,"  and  presents,  therefore,  no  con- 
stant lesion. 

In  the  other  forms  of  rheumatism,  such  as  Rheumatic  Tor- 
ticollis, affecting  the  sterno-mastoid  and  other  muscles;  Lum- 
bago, affecting  the  lumbo-dorsal  fascia,  erectors  spinse  and 
smaller  lumbar  muscles;  Cephalodynia,  attacking  the  occipito- 
frontalis  and  temporal  muscles,  and  the  galea  capitis;  Dorso- 
dyiiia,  of  the  muscles  of  the  upper  part  of  the  back  and  shoulders; 
and  Pleurodynia,  of  the  nbro-muscular  structures  of  the  chest, 
local  derangement  of  nerve  and  blood-supply  is  the  result  of  the 
lesion.  This  lesion  may  be  present  at  the  exact  locality  of  the 
effect,  or  in  the  course  or  at  the  origin  of  the  nerves  supplying 
the  part.  In  the  case  of  muscular  rheumatism  particularly, 
the  fact  that  the  pathology  in  indefinite,  that  no  structural 
changes  occur  in  the  muscles,  and  that  many  authors  regard  it 
as  neuralgia,  well  supports  the  osteopathic  theory  that  it  is  due 
to  bony  or  muscular  lesions  irritating  the  nerve-supply  of  the 
muscles  affected.  This  effect  is  especially  well  shown  in  that 
form  of  muscular  rheumatism  known  as  Lumbago,  in  which  ver- 
tebral lesion,  irritating  the  local  nerve-fibres,  is  regarded  as  the 
cause,  osteopathically,  As  a  matter  of  fact,  one  meets  numer- 
ous cases  diagnosed  as  either  rheumatism  or  neuralgia,  or  to 
which  these  terms  are  applied  interchangeably.  From  an  osteo- 
pathic point  of  view  it  makes  but  little  difference  which  view  of 
the  case  is  taken.  The  essential  fact  is  lesion  irritating  nerve- 
supply,  its  removal  being  the  necessary  therapeutic  measure. 

The  PROGNOSIS,  in  all  forms  of  rheumatism,  is  good.  Even 
the  so-called  incurable  chronic  rheumatism  is  often  cured.  The 
prognosis  is  especially  good  in  inflammatory  and  muscular  rheu- 
matism. In  such  cases  one  expects  to  give  relief  at  one  treat- 
ment. Quick  cures  are  often  made  in  them.  In  chronic  cases 
the  progress  is  slow  because  of  the  deformity,  the  deposit  in  the 
joint,  and  the  thickening  of  the  local  tissues.  Many  of  these 
cases  are  incurable  but  may  be  benefited.  Up  to  a  certain  point 
the  deposits  may  be  absorbed,  the  deformity  overcome,  and  the 
joint  be  put  in  good  condition.  It  is  the  rule,  however,  that  the 
enlargement  or  deformity  of  the  joint  cannot  be  much  relieved, 


PRACTICE    OF    OSTEOPATHY.  357 

though  the  progress  of  the  disease  may  be  stayed. 

The  TREATMENT  of  these  cases  must  be  persistent,  but  not 
severe.  In  inflammatory  rheumatism  the  extreme  pain,  which 
cannot  tolerate  the  slightest  jarring  of  the  floor,  or  movement 
of  the  bed-clothes,  must  be  considered.  Yet  it  does  not  prevent 
treatment  of  the  case.  Delicacy  of  manipulation  enables  one 
to  soon  overcome  the  patient's  fear  and  to  manipulate  the  joints 
at  will.  The  beneficial  effect  of  this  treatment  becomes  at  once 
apparent  in  reduction  of  the  pain  and  inflammation.  Cases 
should  not  be  treated  too  often  or  too  long  at  a  time. 

In  these  cases,  especially  in  rheumatic  fever,  special  at- 
tention must  be  given  to  stimulating  the  activities  of  kidneys, 
liver,  digestive  system,  and  skin,  to  remove  poisons  from  the 
system  and  to  improve  the  condition  of  the  blood.  Often  the 
treatment  is  at  first  confined  to  these  parts,  so  important  is  it 
to  gain  control  of  their  functions. 

A  general  spinal  treatment  is  necessary  in  rheumatic  fever, 
for  constitutional  effects.  A  close  watch  must  be  kept  upon  the 
general  health,  and  lungs  and  heart  must  be  kept  well  stimu- 
lated. Careful  stimulation  of  the  heart  will  prevent  the  disease 
reaching  that  part.  It  is  particularly  necessary  to  provide  against 
the  heart  being  affected. 

The  circulation  to  the  joint,  muscle,  or  part  affected  must  be 
kept  free.  This  is  accomplished  by  work  along  its  vessels,  by 
removal  of  bony  lesion  and  muscular  contracture,  but  especially 
by  springing  the  bones  of  the  joint  so  as  to  separate  them  and 
allow  of  free  circulation  of  the  blood  to  the  membranes.  It  is 
in  this  way  that  the  deposits  are  removed  and  the  membranes 
restored  to  normal  condition. 

In  acute  inflammation  of  a  joint,  also,  its  blood-supply  must 
be  kept  free  and  itself  be  lightly  manipulated,  to  take  down  the 
inflammation. 

In  muscular  rheumatism  the  muscles,  should  be  stretched 
and  manipulated  gently  to  stimulate  the  metabolism  of  the  local 
tissues,  aiding  them  to  throw  off  the  poisonous  substances  sup- 
posed to  collect  in  them. 

In  any  case  the  nerve-supply  of  the  part  must  be  treated 
from  its  origin,  and  the  lesion  be  removed. 


358  PRACTICE    OF   OSTEOPATHY. 

In  lumbago  the  affected  muscles  must  .be  relaxed,  and  the 
lesion  be  reduced.  It  is  readily  affected.  The  patient  may  sit 
upon  a  stool,  while  the  practitioner  stands  in  front  and  passes 
the  arm  about  the  body,  clasping  either  side  of  the  spine  well 
down  toward  the  sacrum.  He  now  raises  and  slightly  rotates 
the  trunk,  first  to  one  side,  then  to  the  other,  relaxing  the  mus- 
cles, separating  the  vertebra1,  and  releasing  the  nerve-fibers  from 
impingement.  By  these  means,  in  most  cases,  a  subluxated  lower 
dorsal  or  lumbar  vertebra,  the  most  usual  cause  of  the  trouble, 
is  set  back  into  place,  and  the  cause  is  removed. 

In  Inflammatory  rheumatism  one  should  look  after  the  hy- 
giene of  the  sick  chamber.  Cold  baths  and  sponging  with  tepid 
water  are  allowable  for  the  fever,  but  are  not  usually  necessary 
under  the  osteopathic  treatment.  The  patient  should  be  be- 
tween blankets,  which  absorb  the  perspiration  and  prevent  chill. 
The  joint  should  be  well  protected  by  being  wrapped  in  some 
soft,  warm  material,  such  as  cotton.  The  diet  should  be  light 
and  nutritious.  Chronic  cases  should  be  protected  from  toil, 
exposure,  etc. 

The  treatment  for  the  special  forms  of  rheumatism  men- 
tioned is  upon  the  same  lines. 

GONORRHEAL  ARTHRITIS,  while  not  properly  regarded  as  a 
rheumatism,  may  yet  be  considered  in  the  same  category  of  treat- 
ment. Specific  bony  lesion  is  commonly  found  at  the  affected 
joint  or  at  the  origin  of  its  nerve-supply,  weakening  the  joint, 
and  laying  it  liable  to  invasion  by  the  poison  of  the  disease. 
Knee  and  ankle  joints  are  most  frequently  affected. 

The   PROGNOSIS,    while   guarded,    is   favorable   for   a    cure. 

There  is  not  the  destruction  of  the  joint  as  in  chronic  articular 

rheumatism,  and  to  a  certain  extent  the  condition  is  more  sure 

•  of  entire  recovery.     Yet  the  progress  of  the  case  is  apt  to  be  slow, 

and  one  must  be  upon  his  guard  against  relapses. 

The  TREATMENT  of  the  joint  is  practically  the  same  as  that 
described  for  articular  rheumatism,  combining  with  it  treatment 
for  the  primary  disease,  looking  particularly  to  the  excretion  of 
the  poison  from  the  system  via  bowels,  liver,  kidneys,  and  skin. 


PRACTICE    OF   OSTEOPATHY.  359 

ARTHRITIS  DEFORMANS  (Rheumatoid  Arthritis.) 

DEFINITION:  A  chronic  disease  of  the  joints,  in  which 
destructive  and  proliferative  changes  occur  in  the  tissues  of  the 
joint.  While  not  a  rheumatism,  it  is  regarded  osteopathically 
from  much  the  same  point  of  view  as  are  the  various  forms  of 
this  disease.  The  lesions  found  are  of  the  same  style  as  those  for 
articular  rheumatism,  occurring  at  the  spinal  origin,  or  in  the 
course,  of  the  nerves  supplying  the  affected  joints.  The  small 
joints  of  the  hands  or  feet,  sometimes  the  large  joints,  are  affected. 
Every  joint  in  the  body  may  finally  become  involved. 

The  PROGNOSIS  is  fair,  but  the  case  will  require  a  long  course 
of  treatment.  The  progress  of  the  disease  can  be  entirely  stopped, 
the  function  of  the  joints  can  be  almost  entirely  restored,  and 
they  can  be  much  reduced  in  size,  pain  can  be  stopped,  and  the 
general  health  can  be  kept  good.  The  deformities  that  have 
taken  place  in  the  joints  cannot  be  removed. 

Most  satisfactory  results  have  been  attained  under  osteo- 
pathic  treatment. 

The  TREATMENT  is  practically  that  outlined  for  articular 
rheumatism.  It  must  be  persistent  in  order  to  repair  the  marked 
changes  that  have  taken  place  in  the  tissues  of  the  joint.  It  is 
of  prime  importance  to  increase  the  suffering  nutrition  of  the 
joint,  and  to  this  end  lesion  must  be  removed  from  blood  and 
nerve-supply,  and  they  must  be  kept  actively  stimulated.  The 
bones  of  the  joint  should  be  spread  apart  as  in  rheumatism,  to 
enable  the  blood  to  circulate  freely  throughout  the  joint.  A 
certain  amount  of  local  treatment  about  the  joint  is  necessary 
to  aid  this  process,  as  well  as  to  affect  the  muscles  and  other  ap- 
pendages of  the  joint,  which  are  suffering  atrophy.  Treatment 
should  begin  at  the  spinal  origin  of  the  nerves  of  the  part  affected. 
A  thorough  course  of  muscular  treatment  for  the  limb  involved 
should  be  carried  out. 

Hygiene  and  diet  should  be  considered.  Plenty  of  meat 
and  vegetables  are  allowed.  Exposure  to  wet  and  cold  must 
be  avoided,  and  bathing  is  recommended. 


360  PRACTICE    OF    OSTEOPATHY. 

GOUT  (Podagra.) 

DEFINITION:  A  constitutional  disease,  in  which  there  is 
arthritis  of  the  small  joints,  and  deposits  of  urates  of  soda  about 
them. 

LESIONS,  as  commonly  found,  affect  the  joint  locally,  its 
innervation,  or  the  kidneys.  One  or  more  such  lesions  may 
be  present  in  any  case.  It  is  common  to  find  a  slight  derange- 
ment of  one  of  the  joints  of  the  great  toe,  or  of  the  part  affected. 
McConnell  notes  lesion  of  the  astragalus.  These  cases  generally 
present  the  characteristic  lesions  of  the  kidney  areas,  weakening 
the  organs,  and  laying  the  system  liable  to  an  accumulation  of 
urates  by  means  of  sedentary  habit,  overeating,  abuse  of  alco- 
hol, etc. 

The  PROGNOSIS  is  good.  Immediate  relief  is  given  during 
the  attack.  The  pain  is  quieted.  Recovery  will  be  complete 
if  the  treatment  is  followed  long  enough. 

The  TREATMENT  looks  at  once  to  the  removal  of  bony  le- 
sion above  described.  It  is  quite  necessary  to  adjust  the  bones 
of  the  joint  involved.  This  may  be  carefully  undertaken  even 
during  an  acute  attack.  The  intense  pain  may  be  relieved  by 
careful  manipulation  of  the  joint  itself  and  by  opening  the  cir- 
culation about  it.  This  takes  down  the  inflammation.  In  this 
stage,  treatment  should  begin  at  the  spinal  origin  of  the  nerves 
of  the  part  involved  and  be  carried  down  the  limb  to  the  joint. 
The  limb  should  receive  a  general  muscular  treatment.  The 
joint  should  be  carefully  stretched.  In  case  of  the  great  toe,  it 
may  be  submitted  to  tension  and  to  slight  motion  from  side  to 
side.  In  urgent  cases  hot  applications  to  the  affected  joint  may 
be  made.  It  may  be  wrapped  in  cotton  woop  and  be  kept  ele- 
vated during  the  intervals  of  treatment.  During  the  acute  stage 
the  patient  should  be  kept  upon  a  diet  of  milk,  farinaceous  food, 
and  plenty  of  water.  Fever  if  persent,  should  be  treated  as 
described  for  fevers.  The  bowels  should  be  kept  well  opened. 

It  is  necessary  to  give  most  thorough  treatment  to  the 
kidneys  to  eliminate  the  urates  from  the  system.  The  blood- 
supply  to  the  joint  should  be  kept  under  treatment  to  cause  ab- 
sorption of  the  deposits  of  urates  in  and  about  it. 


PRACTICE    OF    OSTEOPATHY.  361 

The  joint  should  be  well  protected  from  the  cold,  and  the 
patient  should  be  guarded  against  exposure,  while  at  the  same 
time  the  heart,  stomach,  brain,  etc.,  and  the  general  spinal  sys- 
tem, should  be  kept  well  stimulated  in  order  to  avoid  the  grave 
complication  known  as  retrocedent  gout,  in  which  the  arthritic 
symptoms  are  transferred  to  an  internal  organ. 

The  diet  of  the  gouty  patient  is  a  matter  of  considerable 
importance.  It  should  be  restricted  in  quantity,  and  should 
be  taken  at  regular  hours.  Succulent  vegetables  (cabbage, 
salads,  string-beans;)  farinacea  (rice,  hominy,  etc.);  fruits,  ex- 
cept bananas,  tomatoes  and  strawberries;  fats,  in  the  form  of 
butter;  and  stale  bread  may  be  used.  Meats  are  to  be  restricted; 
•oysters,  fish,  and  fowl  may  be  taken.  All  alcoholic  beverages 
must  be  refused.  Plenty  of  water  and  alkaline  mineral  waters 
.are  good.  Bathing  and  exercise  should  be  regularly  employed. 

LITHEMIA  (Irregular  gout;  American  gout)  is  a  condition 
the  pathology  of  which  is  much  like  that  of  gout,  but  the  joints 
.are  not  very  much  involved.  There  is  an  excess  of  urates  in 
the  blood.  The  kidneys  are  involved,  suffering  from  lesion,  and 
.are  unable  to  keep  the  blood  free  of  these  poisons 

The  PROGNOSIS  is  good.  The  condition  yields  readily  to 
treatment.  Cases  may  be  entirely  cured. 

The  TREATMENT  is  a  most  thorough  and  corrective  one  for 
the  kidneys.  They  must  be  kept  active  in  order  to  free  the 
system  of  the  urates.  A  general  spinal  treatment,  with  atten- 
tion to  bowels,  liver,  stomach,  etc.,  is  necessary  to  increase  the 
nutrition  of  the  body,  and  to  cause  it  to  take  up  more  of  the 
•excess  of  nutriment.  On  the  other  hand,  the  diet  must  be  strictly 
limited.  A  diet  of  cereals  and  fruit  is  particularly  good,  meat 
being  entirely  omitted.  Alcohol,  tea,  coffee,  and  tobacco  are 
best  not  taken.  Sweets,  fats,  butter  and  cheese  are  hot  to  be 
taken.  The  patient  should  drink  plenty  of  water. 

The  liver  should  be  kept  well  treated  to  avoid  hemorrhoids 
•and  biliousness.  The  general  spinal  and  special  treatment  for 
nervous  and  digestive  systems  aid  in  keeping  the  patient  free 
from  many  annoying  symptoms.  Further  symptomatic  treat- 
ment may  be  given  as  necessary. 


362  PRACTICE    OF    OSTEOPATHY. 

OBESITY.  (Polysarcia,  Lipomatosis  Universalis.) 

DEFINITION:  A  condition  due  to  an  increase  of  fat  in  the 
tissues  of  the  body,  sufficiently  great  to  impair  functions,  and 
showing  lesion  to  the  lymphatic  system,  liver,  pancreas,  etc. 

CASES:  (1)  A  case  of  obesity  in  which  there  was  marked 
pathological  condition  of  liver  and  kidneys.  Treatment  was 
directed  particularly  to  these  organs,and  a  strict  diet  was  enforced. 
In  ten  days  the  patient  began  to  improve,  and  at  the  end  of  two 
weeks  found  that  he  had  lost  ten  pounds.  After  one  month 
the  treatment  was  discontinued,  as  the  patient  left  the  city  tem- 
porarily. Returning  later  he  reported  a  loss  of  twenty-five 
pounds  and  the  enjoyment  of  better  health  than  for  a  long  time, 

(2)  A   second  case,    treated  upon    the  same  plan,   lost   37 
pounds  in  two  months,  and  the  health  improved. 

(3)  A   case   of   obesity   reduced   23   pounds  in   five  months 
treatment. 

Numerous  cases  have  been  successfully  treated. 

The  LESIONS  in  these  cases  are  largely  spinal  vertebral  ones 
affecting  the  innervation  of  the  lymphatic  system,  of  the  liver, 
and  of  the  pancreas  Dr.  Still  points  out  spinal  lesion  to  the 
full  length  of  the  thoracic  duct,  acting  through  the  various  spinal 
sympathetic  connections,  splanchnics,  etc.  He  mentions  es- 
pecially lesion  at  the  4th  dorsal,  which  he  calls  a  center  for  nutri- 
tion, and  at  the  7th  cervical,  opposite  which  the  duct  ends.  He 
has  called  attention  to  lesion  in  the  upper  dorsal  region,  just 
below  the  cervical,  giving  rise  to  the  growth  of  a  fleshy  cushion, 
a  condition  of  affairs  that  seems  to  influence  the  lymphatic  sys- 
tem and  cause  a  deposition  of  fat.  He  also  works  high  in  the 
cervical  region,  opposite  the  transverse  processes  of  the  vertebrae, 
for  nerves  controlling  the  calibre  of  the  duct. 

Lesion  at  the  1st  and  2nd  ribs,  and  at  the  clavicle,  are  found 
in  some  cases.  They  may  cause  pressure  upon,  and  obstruction 
of,  the  thoracic  and  right  lymphatic  ducts  where  they  empty 
into  the  innominate  veins. 

Obstructive  lesions  to  the  nerves  controlling  the  lymphatics 
or  to  the  lymphatics  directly,  prevent  the  proper  flow  of  the 
lymphatic  fluid  containing  the  saponified  and  emulsified  fat  ah- 


PRACTICE    OF    OSTEOPATHY.  363 

sorbed  by  the  lacteals.  Thus  the  fat  is  not  freely  enough  poured 
into  the  circulation  and  passed  to  the  lungs  to  be  oxidized,  there 
and  in  the  arterial  blood,  and  as  a  result  the  fat  is  deposited  in 
the  tissues  of  the  body.  Lack  of  oxidization  of  the  fats  is  a  well 
known  cause  of  obesity. 

Splanchnic  spinal  lesion  is  also  a  factor  in  such  conditions. 
It  acts  probably  in  more  than  one  way.  In  the  first  place  it 
may  aid  in  disturbing  the  nerve-control  of  the  thoracic  duct 
and  receptaculum.  But  it  probably  also  affects  the  activities 
of  pancreas  and  liver.  Lower  rib  lesion  could  do  the  same 
thing. 

*The  pancreatic  fluid  and  the  bile,  chiefly  the  former,  emul- 
sify and  saponify  the  fats,  preparing  them  for  absorption  into 
the  lymph  capillary  of  the  lacteal,  whence  they  are  carried  into 
the  thoracic  duct,  and  to  the  circulation  to  the  lungs  for  oxidiza- 
tion. Deficiency  of  these  secretions  would  thus  prevent  the 
proper  preparation  of  the  fats  for  absorption  and  further  elabor- 
tion.  The  American  Text  Book  of  Physiology  states  that  the 
bile  acids  stimulate  the  epithelial  cells  to  a  greater  activity  in 
the  absorption  of  fats.  As  the  fats  are  not  properly  prepared 
by  the  action  of  the  pancreatic  and  liver  secretions,  it  seems 
probable  that  they  are  absorbed  into  the  circulation  directly 
from  the  intestine,  and,  not  being  in  a  state  for  oxidization,  are 
carried  through  the  portal  circulation  and  deposited  in  the  tis- 
sues. Of  course  much  of  the  fat  is  passed  from  the  intestine  with 
the  fecal  matter. 

Thus  excess  of  fats  and  starches  in  the  diet  is  deposited  as 
adipose  tissue. 

The  PROGNOSIS  is  fair  in  cases  of  obesity.  If  the  fat  is  solid 
and  healthy,  and  the  general  health  good  it  is  difficult, to  reduce 
the  fat  except  by  careful  dieting  and  exercise.  But  if  the  fat 
is  soft  and  flabby,  it  may  be  greatly  reduced  by  proper  treatment. 
Many  cases  have  been  treated  successfully  osteopathically. 

The  TREATMENT  must  be  directed  to  the  correction  of  the 
lesions  described.  It  is  essential  to  keep  normal  the  functions  of 
liver  and  pancreas.  They  should  be  treated  by  local  abdominal 
work,  and  by  the  removal  of  lesion.  If  the  cushion  of  flesh  ap- 

*Phila.  Jour.  Osteopathy,  Nov.  '99.  p.  6. 


364  PRACTICE  OF  OSTEOPATHY. 

pears  in  the  upper  dorsal  region  it  should  be  treated  by  direct 
manipulation,  causing  it  to  be  gradually  absorbed.  All  sources 
of  obstruction  to  the  lymphatics  and  to  their  irmervation  must 
be  removed. 

The  heart  should  be  kept  stimulated,  on  account  of  its  ten- 
dency to  weakness  and  fatty  degeneration.  The  breathlessness 
often  present  should  be  treated  by  raising  the  ribs  as  in  asthma. 
Kidneys  must  be  kept  active,  and  be  stimulated  against  nephritis, 
which  is  apt  to  come  on  late  in  the  disease. 

A  thorough  general  spinal  and  muscular  treatment,  includ- 
ing limbs,  abdomen,  chest,  etc.,  aids  in  the  oxidization  of  the 
fat  in  the  tissues.  A  course  of  exercise  may  be  prescribed  with 
the  same  object.  It  should  not  be  too  severe  in  patients  with 
weak  hearts  and  vascular  systems. 

Lungs  and  stomach  should  be  kept  treated.  The  latter  is 
apt  to  be  dilated,  and  to  suffer  from  gastritis.  The  lungs  are 
likely  to  suffer  enlargement  and  fatty  infiltration. 

A  strict  diet  should  be  enforced  in  these  cases.  This  is  an 
essential  part  of  the  treatment  of  them.  The  amount  of  food 
should  be  small.  Starches,  fats,  and  sweets  are  to  be  excluded. 
The  amount,  of  water  allowed  is  small,  and  alcoholic  drinks  are 
forbidden.  It  is  well  to  follow  some  prescribed  dietary  such  as 
Oertel's,  Ebstein's,  or  Banting's. 

Severe  exercises  must  not  be  prescribed  in  cases  in  which 
heart  and  vessels  are  not  perfectly  sound. 

RICKETS  (Rachitis). 

DEFINITION:  A  constitutional  disease  of  children,  in  which 
there  is  marked  nutritive  change  in  bones  and  cartilages,  result- 
ing in  defoimities. 

It  is  a  general  nutritive  disturbance,  and  there  are  no  con- 
stant bony  lesions.  Improper  hygiene  and  nutrition  are  the 
causal  factors. 

Osteopathic  treatment  has  been  successful  in  the  handling 
of  these  cases.  The  progress  of  the  disease  may  be  limited, 
further  deformity  is  prevented,  but  deformities  once  confirmed 
cannot  be  corrected.  Beginning  deformities  may  be  corrected. 

The  TREATMENT  is  mainly  such  a  change  in  the  diet  as  to 


PRACTICE  OF  OSTEOPATHY.  365 

supply  the  elements  lacking  in  the  nutrition  of  the  body.  In 
case  the  babe  cannot  be  properly  nourished  by  the  mother's 
milk,  cow's  milk  diluted  is  found  to  be  the  most  satisfactory  sub- 
stitute. Barley  water  is  also  recommended.  The  feeding  should 
not  be  too  frequent  nor  excessive  in  amount.  Older  children  are 
allowed  light  meats%  vegetables  and  fruit. 

The  hygienic  treatment  is  quite  as  important.  Plenty  of 
fresh  air  and  sunshine,  and  daily  bathing  are  very  helpful.  The 
child  should  not  be  allowed  to  lie  much  in  one  position.  This 
should  be  frequently  changed.  It  should  be  kept  from  walking 
until  danger  of  deformity  is  past. 

With  this  treatment  the  value  of  proper  osteopathic  treat- 
ment cannot  be  overestimated.  Its  effects  in  increasing  gen- 
eral nutrition  of  the  body  are  well  demonstrated.  A  thorough, 
but  careful,  general  spinal  treatment  should  be  given.  This 
reaches  the  general  nervous  system  and  affects  function  through- 
out the  body.  It  also  aids  in  overcoming  the  nervous  symptoms 
manifest  in  the  case.  The  liver,  spleen,  and  kidneys  should  be 
treated,  as  they  may  be  involved.  The  bowels  should  be  kept 
free. 

A  general  muscular,  abdominal  and  cervical  treatment 
should  be  added  to  the  general  spinal  treatment.  Impaired 
nutrition  of  certain  muscles  may  lead  to  a  semblance  of  paralysis. 
These  muscles  should  be  well  treated  to  build  them  up. 

If  the  bony  parts  are  yet  soft  much  may  be  done  to  restore 
shape  of  the  parts.  A  curvature  of  the  spine  may  be  entirely 
cured.  Treatment  should  be  directed  to  shaping  of  the  parts 
undergoing  deformity. 

DIABETES  MELLITUS  AND  DIABETES  INSIPIDUS. 

CASES:  (1)  Diabetes  Mellitus  in  a  man  of  thirty-four. 
The  disease  was  well  established  by  urinalysis  and  the  charac- 
teristic symptoms.  The  patient  was  a  great  sufferer  from  pain 
in  the  lower  dorsal  and  lumbar  regions,  and  showed  bony  lesions 
at  the  12th  dorsal,  second  and  fifth  lumbar  vertebrae.  He  was 
discharged  cured  after  months  treatment,  and  has  since  passed 
the  medical  examination  for  life  insurance,  being  pronounced  a 
good  risk. 


366  PRACTICE  OF  OSTEOPATHY. 

(2)  Diabetes  Mellitus  in  a  young  man  of  nineteen ,  who  had 
been  given  up  to  die.     He  was  passing  nine  pints  per  day  of 
urine  of  a  sp.  gr.  of  1054.     In  one  week  it  was  reduced  to  1048, 
and  four  pints  per  day.     He  gained  strength  daily,   and   was 
practically  cured  at  the  time  of  report. 

(3)  Diabetes  Mellitus  in  a  lady  of  fifty-six.     The  patient 
had  lost  eighty  pounds  in  six  months,  and*  her  symptoms  were 
very   marked.     The   case   was   expected   to   die.     Lesions   were 
found  in  the  upper  cervical  vertebrae,  also  of  the  2nd  and  3rd 
dorsal,  and  lower  dorsal  and  upper  lumbar  veitebrse.     The  sp. 
gr.  of  the  urine  was  1043,  sugar  4  per  cent,  and  quantity  from  10 
to  18  pints  per  diem.     Improvement  was  continuous  from  the 
first,  and  in  five  months  the  case  was  cured. 

(4)  Diabetes   Mellitus  in   a   lady    of   fifty-six.     She   passed 
about  200  ounces  of  urine  each  day,  containing  a  large  percentage 
of  sugar.     Lesion:  A  depression  of  the  right  ribs  over  the  region 
of  the  liver.     The  case  showed  marked  improvement  under  the 
treatment.     In  four -months  the  general  symptoms  were  much 
improved,  and  the  quantity  of  sugar  was  less  than  half  as  much 
as  at  first. 

(5)  Diabetes  Mellitus,  in  which  lesions  were  found  in  the 
lower  dorsal  and  lumbar  region.     Also  in  the  cervical  region  and 
at  the  atlas.     Marked  improvement  took  place  under  treatment, 
but  the  treatment  was  discontinued  before  a  cure  was  affected. 

(6)  Diabetes   Mellitus   showing   lesion   in   the   lower  dorsal 
and   lumbar   regions.     The   treatment   was   continued   for   four 
months,  and  the  case  was  completely  cured,  the  patient  passing 
a  medical  examination  for  life  insurance. 

(7)  Diabetes  Mellitus  in  a  man  fifty-one  years  of  age.     Le- 
sions was  a  posterior  condition  of  the  spine  from  the  sixth  dorsal 
to  the  second  lumbar  vertebra.     At  the  time  of  report  one  months 
treatment  had  been  taken,  and  improvement  was  made. 

(8)  Diabetes    Mellitus   showing   lesion    in    the    cervical   and 
lower  dorsal  regions.     The  urine  contained  two  per  cent  of  sugar. 
Complete  cure  was  made. 

LESIONS  causing  diabetes  are  usually  bony  lesions  along 
the  spine  from  the  middle  dorsal  to  the  lower  lumbar  region. 
McConnell  notes  the  fact  that  in  a  number  of  cases  there  was 


PRACTICE    OF    OSTEOPATHY.  H67 

a  posterior  swerve  of  the  spine  form  the  middle  dorsal  to  the 
upper  lumbar  region. 

Sacral  lesion  has  been  noted  in  these  cases,  some  showing 
a  slip  of  the  ilium,  some  lesion  of  the  fifth  lumbar.  Cervical 
lesion,  chiefly  in  the  upper  cervical  region  is  sometimes  found 
in  diabetes  mellitus.  Sometimes  a  rib  lesion,  as  in  case  4,  occurs 
in  the  region  of  the  liver  or  of  the  splanchnics. 

Lesions  of  the  dorsal  and  upper  lumbar  region  involve  the 
in  nervation  of  these  organs,  derangement  of  which  is  thought  to 
be  most  closely  associated  with  diabetes.  Through  their  effects 
upon  the  splanchnics  and  solar  plexus,  they  derange  the  func- 
tions of  the  liver,  pancreas,  and  intestines,  all  thought  to  be  im- 
plicated in  this  condition.  It  is  well  established  that  pancreatic 
disease  is  usually  closely  associated  with  diabetes;  that  a  gly- 
colytic  ferment  secreted  by  this  gland  is  necessary  to  normal 
metabolism.  This  being  disturbed  results  in  sugar  in  the  urine. 
Such  a  result  is  doubtless  affected  by  such  lesions  as  above,  in- 
terfering with  the  innervation  of  the  organ  by  way  of  the  solar 
and  splenic  plexuses. 

It  has  already  been  shown  how  closely  are  such  lesions  as- 
sociated with  derangement  of  the  liver  innervation,  the  glyco- 
genic  function  of  the  organ  being  disturbed  in  diabetes. 

It  may  be  that  these  lesions  likewise  aid  the  condition  by 
deranging  the  activities  of  the  intestinal  villi.  According  to 
Pavy's  view  of  diabetes,  a  disturbance  in  the  functions  of  the 
cells  of  the  intestinal  villi  is  the  essential  feature  in  the  causation 
of  diabetes.  Lesion  to  the  vaso-motor  innervation  of  the  portal 
vessels,  arising  from  the  5th  to  9th  dorsal  may  have  something 
to  do  with  such  a  disturbance.  Lesion  to  the  upper  region  may 
aid  this  effect. 

The  influence  of  the  general  nervous  system  in  diabetes  is 
well  known,  but  not  well  understood.  It  is  shown  that  lesions 
to  the  medulla,  cord  and  sympathetic  system  cause  diabetes. 
The  various  spinal  and  cervical  bony  lesions  doubtless  could  do 
the  mischief  resulting  in  diabetes,  as  it  has  been  shown  frequently 
that  these  lesions  may  injure  cord,  medulla,  or  sympathetic 
system,  as  in  paralysis,  etc.  In  this  connection  one  sees  the 
importance  of  upper  cervical  lesions,  which  affect  the  medulla. 


368  PRACTICE    OF    OSTEOPATHY. 

Here,  in  the  floor  of  the  fourth  ventricle,  lies  the  so-called  diabetic 
center.  It  is  a  point,  puncture  at  which  results  in  diabetes. 
The  effect  is  doubtless  gotten  through  the  vagi  nerves,  whose 
origin  is  from  this  point.  With  regard  to  this  fact,  also  to  the 
well  known  participation  of  the  vagi  in  liver  functions,  it  seems 
that  cervical  and  spinal  lesion,  affecting  the  vagi  through  their 
sympathetic  cervical  connections,  or  through  their  connections 
with  the  solar  plexus,  may  in  this  way  produce  a  part  of  the 
effect  of  lesion  in  diabetes. 

PROGNOSIS:  Although  diabetes  mellitus  is  a  grave,  and, 
by  ordinary  methods,  an  incurable  disease,  the  outcome  under 
osteopathic  treatment  is  usually  more  encouraging.  A  fair 
percentage  of  cures  has  been  shown,  there  being  no  room  for 
doubting  the  facts  in  such  cases.  In  accounts  of  twenty-six 
cases  gathered  by  Dr.  C.  W.  Proctor,  thirteen  improved  con- 
tinually under  the  treatment;  seven  were  entirely  cured;  others 
were  yet  under  treatment. 

It  may  be  well  said  that  in  such  cases  our  prognosis  for  re- 
covery is  fair,  and  for  benefit  is  good. 

The  TREATMENT  ,is  mainly,  as  far  as  the  specific  treatment 
is  concerned,  upon  that  portion  of  the  spine  most  affected  with 
lesion,  namely  along  the  splanchnic  and  lumbar  regions.  It  is 
of  course  necessary  to  remove  the  lesion  as  soon  as  possible. 
Treatment  at  the  above  mentioned  regions  is  particularly  for 
restoring  the  normal  functions  of  pancreas,  liver  and  small  in- 
testine. 

As  the  heart,  kidneys,  lungs  and  spleen  undergo  patholog- 
ical changes,  it  is  necessary  to  give  special  attention  to  their 
condition,  according  to  methods  before  given.  The  skin  and 
general  excretory  system  must  be  stimulated  to  aid  in  excreting 
the  sugar  from  the  blood.  The  bowels  must  be  treated  for  the 
constipation  which  is  usually  present. 

A  thorough  general  systemic  treatment  is  given  for  the 
purpose  of  affecting  the  various  organs  involved  in  the  disease, 
stimulating  and  increasing  the  general  nutrition  of  the  body 
which  is  much  affected,  and  upbuilding  the  general  nervous 
system. 

It  is  necessary  to  give  close  attention  to  the  diet  and  reg- 


PRACTICE    OF    OSTEOPATHY.  369 

imen  of  the  patient.  Carbohydrates  must  be  excluded  from 
the  diet  as  thoroughly  as  possible,  no  sugars  nor  starches  being 
allowed  in  any  form.  Meats,  fish,  poultry,  eggs,  and  green  veg- 
etables which  do  not  contain  starch  (string-beans,  lettuce,  water- 
cress, spinach,  young  onions,  tomatoes,  olives,  celery)  are  allowed. 
So,  likewise,  are  milk,  cream,  butter,  and  cheese.  The  patient 
should  drink  plenty  of  water,  especially  such  alkaline  mineral 
waters  as  Vichy,  Carlsbad,  etc. 

He  should  take  light  exercise,  but  should  avoid  fatigue, 
particularly  inimical  to  his  weakened  condition.  For  the  same 
reason,  while  warm  and  steam  baths  are  recommended,  they 
should  not  be  prolonged  for  fear  of  a  weakening  effect. 

In  DIABETES  INSIPIDUS  the  lesions  are  usually  found  in  the 
lower  splanchnic  area,  affecting  the  kidneys.  Some  cases  show 
lesion  of  the  superior  cervical  vertebrae.  In  the  latter  case  the 
effect  may  be  upon  the  medulla,  or  upon  the  sympathetic  sys- 
tem. There  is  a  point  in  the  floor  of  the  fourth  ventricle,  punc- 
ture at  which  causes  diabetes  insipidus. 

These  various  bony  lesions  may  cause  it  by  affecting  the 
cord,  since  it  is  known  that  injuries  to  the  cerebro-spinal  axis 
result  in  the  disease.  Anders  regards  the  condition  as  a  vaso- 
motor  neurosis,  usually  of  central,  sometimes  of  reflex  origin. 
It  is  also  thought  to  be  due  to  a  vaso-motor  relaxation  of  the  kid- 
neys. It  is  readily  seen  that  spinal  lesion  to  the  renal  splanchnic 
could  result  in  this  vaso-motor  neurosis  and  give  rise  to  the  dis- 
ease. 

The  PROGNOSIS  is  good  under  osteopathic  treatment,  al- 
though the  condition  is  regarded  as  incurable.  A  fair  number 
of  cases  are  cured. 

The  TREATMENT  is  mainly  local  for  the  kidneys,  by  removal 
of  lesion  at  the  splanchnic  areas  arid  by  the  various  special  ways 
of  affecting  the  kidneys  as  pointed  out  in  considering  diseases 
of  the  kidneys. 

Some  general  treatment  for  the  nervous  system  may  be 
necessary. 


370  PRACTICE  OF  OSTEOPATHY. 

INFECTIOUS  DISEASES. 

DIPHTHERIA. 

Numerous  cases  have  been  treated  successfully  by  osteo- 
pathy. The  LESIONS  usually  found  in  such  cases  are  muscular 
and  bony  lesions  in  the  neck.  Dr.  Still  regards  the  important 
cause  a  contraction  of  the  tissues  of  the  throat  and  neck,  includ- 
ing the  scaleni  muscles,  drawing  the  first  rib  backward  under 
the  clavicle  and  thus  disturbing  its  articulation  with  the  first 
dorsal  vertebra.  These  contractions  about  the  throat  interfere 
\rith  the  venous  circulation  through  the  pharyngeal  and  internal 
jugular  veins,  favoring  a  congested  or  eatarrhal  condition  of  the 
mucous  membranes  of  the  throat,  and  leading  to  diphtheria. 
It  is  well  known  that  catarrhal  conditions  predispose  to  the 


Bony  lesions  and  muscular  contractures  in  the  cervical 
region  interfere  with  the  innervation  of  the  muscles  and  mucous 
membrane  of  the  throat.  The  sympathetic  innervation  is  from 
the  superior  cervical  ganglion.  This  distribution  unites  with 
fibres  from  the  pneuinogastrie.  glosso-pharyngeal  and  external 
laryngeal  nerves,  forming  the  pharvngeal  plexus.  Hence  upper 
cervical  lesion  may.  by  affecting  the  superior  cervical  ganglion, 
derange  the  sympathetic  vaso-motor  supply  of  the  pharvngeal 
mucous  membranes  and  lead  to  the  dise.-i- 

The  PROGNOSIS  is  good.     The  case  is  usually  readily  cured. 

In  the  TRRATMKNT  the  main  idea  is  to  keep  open  the  circu- 
lation to  the  throat  and  to  thus  prevent  the  formation  of  the 
membrane,  or  to  prevent  its  further  growth.  A  thorough  re- 
laxation of  the  muscles  and  anterior  tissues  of  the  neck  must 
be  maintained.  The  tissues  at  the  root  of  the  neck,  and  about 
the  clavicle  and  first  rib  must  also  l>e  kept  free  and  loose.  The 
clavicle  should  be  raised.  The  first  rib  should  be  pressed  down- 
ward and  forward,  working  at  its  central  articulation  to  correct 
the  position  of  its  head.  By  the  process  of  these  treatments  the 
venous  and  lymphatic  drainage  from  about  the  throat  is 
open.  This  regulates  the  vaso-motor  disturbance  of  the  mem- 
branes, tends  to  loosen  the  membranes  already  formed,  and.  by 


PRACTICE    OF    OSTEOPATHY.  371 

preventing  further  exudation,  stops  the  further  growth  of  the 
membrane. 

The  splanchnics,  liver,  kidneys  and  bowels  should  be  treated 
twice  daily,  to  keep  free  the  excretion  of  poison  from  the  system, 
and  to  aid  nutrition,  to  keep  up  the  strength  of  the  system. 

Cervical  bony  lesion  should  be  removed,  and  treatment 
should  be  given  to  the  vagi,  superior  cervical  ganglion,  and  cer- 
vical sympathetic^,  to  correct  circulation  and  aid  in  gaining 
vaso-motor  control. 

The  internal  throat  treatment  should  be  given  to  aid  in 
gaining  the  same  end.  Proper  precautions  should  be  taken 
to  protect  the  finger  so  that  the  child  may  not  wound  it  with 
his  teeth.  The  finger  is  inserted  and  swept  down  over  soft  and 
hard  palate,  fauces  and  tonsils,  to  relieve  the  local  inflammation 
by  starting  the  circulation. 

In  laryngeal  diphtheria  an  external  treatment  about  the 
larynx  and  down  along  the  trachea  is  good.  (Chap.  III.  A.  V.) 
Laryngeal  intubation  should  be  done  in  case  of  threatened  suf- 
focation. 

A  general  systemic  treatment  should  be  carefully  given 
to  build  up  the  strength.  The  heart  and  lungs  should  be  care- 
fully stimulated  to  avoid  complications  in  them.  The  case 
should  be  carefully  looked  after  for  some  time,  to  strengthen  the 
heart  and  to  overcome  the  weakness  of  the  throat. 

The  general  treatment  aids  in  preventing  paralysis,  par- 
ticularly apt  to  occur  about  the  throat,  sometimes  in  other  parts 
of  the  body. 

The  patient  should  be  isolated  and  the  usual  antiseptic 
precautions  should  be  practiced.  The  patient  should  be  kept 
upon  a  liquid  diet.  Milk,  ice  cream,  broths,  and  the  like  are 
used. 

CROUP. 

(Spasmodic  Croup,  Catarrhal  Croup,  or  Laryngi.smus  Strid- 
utafl.) 

Jn.ii  \rno.N :  This  is  a  disease  peculiar  to  children  and 
h»-ld  to  be  chiefly  of  nervous  origin,  but  it  is  often  a.--o<-iat<-d 
with  acute  catarrhal  laryngitis.  It  is  associated  with  paroxys- 


372  PRACTICE    OF    OSTEOPATHY. 

mal  coughing,  difficulty  of  breathing,  and  attacks  of  threatened 
suffocation. 

Numerous  cases  have  been  successfully  treated  by  osteo- 
pathy. 

The  LESIONS  of  greatest  importance  in  croup  involve  con- 
tracturing  of  the  muscles  and  tissues  of  the  throat,  irritating  the 
pneumogastric  nerves,  and  their  recurrent  and  superior  laryngeal 
branches.  These  contractures  likewise  prevent  proper  circu- 
lation to  and  from  the  larynx,  and  favor  the  catarrhal  condition 
in  this  way.  The  irritation  of  the  pneumogastrics  and  their 
branches  is  accountable  for  the  spasmodic  condition  of  the  larynx 
during  the  paroxysms. 

Dr.  Still  regards  as  important  sacral  and  lower  spinal  bony 
lesions  in  croup.  He  a,lso  finds  a  contracture  of  the  omohyoid 
muscle,  drawing  the  hybid  bone  down  and  back  upon  the  superior 
laryngeal  nerve,  irritating  it,  and  causing  the  spasm.  In  croup, 
as  in  other  throat  diseases,  he  finds  that  the  contracture  of  the 
cervical  tissues  and  scaleni  muscles  draws  the  first  rib  back  under 
the  clavicle,  draws  it  upward,  and  deranges  its  articulation  with 
the  first  dorsal  vertebra.  This  condition  is  important  in  shutting 
off  venous  and  lymphatic  drainage  from  the  larynx,  and  favors 
the  inflammation  of  the  mucous  membrane. 

Various  contractures  of  the  posterior  cervical  muscles,  as 
well  as  those  bony  lesions  common  in  laryngitis,  as  of  atlas,  axis, 
and  3rd  cervical  vertebra,  are  sometimes  present,  acting  to  dis- 
turb sympathetic  innervation,  vagi,  and  circulation. 

One,  must,  however,  chiefly  regard  those  contractures  and 
bony  lesions  about  the  throat  and  neck  anteriorly.  Arising  from 
exposure,  cold,  etc.,  they  become  the  chief  cause  of  croup. 

The  PROGNOSIS  is  good.  Immediate  relief  is  given  by  the 
treatment.  The  spasm,  stridulous  breathing,  and  threatened 
suffocation  are  overcome  at  once  by  the  treatment  during  the 
attack. 

The  chief  TREATMENT  is  to  at  once  relax  all  the  anterior 
cervical  tissues,  to  free  the  circulation  and  to  relieve  the  irrita- 
tion to  the  superior  and  recurrent  laryngeal  nerves.  The  treat- 
ment should  begin  well  up  beneath  the  inferior  maxillary  bone. 
being  made  especially  about  the  hyoid  bone  and  muscles  and 


PRACTICE    OF    OSTEOPATHY.  373 

should  be  carried  down  along  the  throat  and  trachea. 

The  hyoid  bone  should  be  grasped  and  manipulated  laterally, 
forward,  and  upward,  relaxing  the  omohyoid  and  other  muscles. 
(Chap.  Ill,  A,  III,  Chap.  IV,  III.) 

The  process  of  freeing  the  circulation  is  materially  aided 
by  working  along  the  course  of  the  carotid  arteries  and  internal 
jugular  veins,  raising  the  clavicle,  and  relaxing  the  surrounding 
tissues. 

Treatment  may  be  made  close  along  the  larynx  and  trachea. 
.(Chap.  Ill,  A.  V.)  This  is  helpful  during  the  spasm. 

Inhibition  may  be  made  upon  the  superior  laryngeal  nerve 
by  pressure  immediately  below  and  behind  the  greater  cornua 
of  the  hyoid  bone,  and  upon  the  recurrent  laryngeal  at  the  inner 
side  of  the  sterno-mastoid  muscle  at  the  level  of  the  cricoid  car- 
tilage. This  is  likewise  useful  during  the  spasm. 

Anders  notes  the  fact  that  sometimes  the  epiglottis  becomes 
wedged  into  the  rima  glottidis,  and  must  be  helped  out  by  the 
use  of  the  index  finger. 

The  spasm  may  be  lessened  by  manipulation  about  the 
region  of  the  diaphragm,  relaxing  it,  and  by  treatment  of  the 
phrenic  nerves  in  the  neck.  (Chap.  Ill,  A.  VIII.) 

Due  attention  must  be  given  to  the  tissues  and  bony  lesions 
of  the  posterior  cervical  region. 

All  sources  of  reflex  irritation,  as  intestinal  parasites,  den- 
tition, indigestion,  etc.,  must  be  looked  after.  The  child  should 
not  be  allowed  to  over-eat  or  drink. 

In  spasmodic  croup  the  attack  is  sometimes  relieved  by 
easing  an  overloaded  stomach.  Tickling  the  fauces  with  the 
finger  will  cause  the  vomiting.  Cold  applications  may  be  used 
over  the  throat  and  chest.  A  warm  bath  is  a  convenient  means 
to  break  up  a  spasm. 

WHOOPING-COUGH. 

(PERTUSSIS.) 

DEFINITION:  An  acute,  highly  contagious  disease,  occurring 
chiefly  in  children,  and  characterized  by  a  catarrhal  inflammation 
of  the  mucous  membrane  of  the  respiratory  tract,  and  by  a  pecu- 
liar spasmodic  cough  ending  in  a  whooping  inspiration. 


374  PRACTICE    OF    OSTEOPATHY. 

Its  true  nature  is  not  known,  but  that  theory  that  regards 
it  as  a  lesion  of  the  phrenic,  pneumogastric,  sympathetic,  or 
recurrent  laryngeal  nerve,  or  perhaps  of  the  medulla,  best  ac- 
cords with  the  osteopathic  view  of  the  etiology. 

The  PROGNOSIS  is  good.  The  case  may  be  aborted  if  taken 
early,  but  if  the  disease  is  well  started  but  little  more  than  allevia- 
tion can  be  accomplished.  The  case  is  safely  carried  through, 
and  the  danger  of  complication  is  minimized. 

The  LESIONS:  In  whooping-cough,  as  in  croup,  the  con- 
traction of  the  omohyoid  muscle,  drawing  the  hyoid  bone  against 
the  pneumogastric  nerve,  is  important,  as  is  also  the  contrac- 
turing  of  the  cervical  tissues  drawing  the  first  rib  back,  and  dis- 
turbing its  central  articulation. 

Cervical  bony  lesions  are  found  at  the  upper,  middle,  and 
lower  cervical  vertebra?,  and  bony  lesions  are  also  found  about 
the  first  and  second  dorsal  vertebrae,  the  first  rib  and  clavicle. 

The  upper  cervical  lesion  affects  sympathetics  and  vagi 
in  ways  before  pointed  out.  The  middle  cervical  lesion  affects 
phrenics  and  diaphragm,  sometimes  important  in  this  condition. 
The  contractures  of  'throat  tissues,  lesion  of  clavicle  and  first 
rib  retard  venous  and  lymphatic  drainage,  and  lead  to  catarrhal 
conditions,  well  known  to  be  of  much  importance  in  producing 
the  condition.  The  mucous  membranes  are  thus  weakened  and 
laid  liable  to  the  action  of  the  specific  infection. 

Lesions  of  the  upper  dorsal  vertebrae  and  of  the  upper  two 
or  three  ribs  may  derange  the  sympathetic  connections  of  the 
laryngeal  innervation. 

The  TREATMENT  is  much  the  same  as  in  croup.  The  prime 
point  is  to  free  the  circulation  about  the  larynx  and  whole  re- 
spiratory tract,  as  there  is  a  catarrhal  condition  of  the  whole 
tract.  This  object  involves  the  relaxation  of  all  the  anterior 
cervical  tissues,  treatment  of  the  hyoid  bone,  and  relaxation  of 
the  omo-hyoid,  raising  the  clavicle,  etc.  All  bony  lesions  of  the 
cervical,  upper  dorsal,  and  upper  thoracic  region  must  be  over- 
come, together  with  existing  contractures,  in  order  to  remove 
all  sources  of  irritation  to  the  laryngeal  innervation.  The  ways 
in  which  these  lesions  act,  and  the  method  of  their  removal  has 
before  been  sufficiently  explained. 


PRACTICE    OF   OSTEOPATHY.  375 

For  the  cough,  treatment  should  be  made  down  along  larynx 
and  trachea,  and  about  the  angle  of  the  jaw. 

Dr.  Still  mentions,  also,  treatment  to  the  phrenic  nerves 
and  diaphragm  to  relieve  the  condition. 

The  lungs  may  be  stimulated,  and  all  the  upper  ribs  be 
raised,  to  ease  respiration.  The  lungs,  heart,  kidneys,  and  gen- 
eral system  must  be  carefully  looked  after  and  thoroughly  treated 
to  avoid  the  complications  and  sequelae  that  may  arise  in  the 
form  of  broncho-pneumonia,  pleurisy,  pericarditis,  acute  nephritis. 

"Jacob  Sobel  gives  the  results  of  his  own  experience  with 
the  paroxysms  of  whooping  cough  treated  by  pulling  the  lower 
jaw  downward  and  forward.  Pulling  the  lower  jaw  downward 
and  forward  controls  the  paroxysms  of  whooping  cough  in  most 
instances  and  most  of  the  time.  The  method  is  usually  more 
successful  in  older  children  than  in  younger  ones  and  infants. 
In  cases  without  a  whoop  the  expiratory  spasm  with  its  asphyxia 
is  generally  overcome,  and  in  those  with  a  whoop  the  later  is 
prevented.  It  is  as  successful  as  any  single  drug,  or  even  more 
so.  Mothers  should  be  instructed  in  its  use,  so  that  attacks, 
especially  at  night,  might  be  arrested.  The  manipulation  is 
harmless  and  painless.  Its  only  centra-indication  is  the  presence 
of  food  in  the  mouth  or  oesophagus.  Patients  thus  treated  are 
less  likely  to  suffer  from  complications  and  sequelae  than  those 
treated  only  medicinally.  It  is  advisable  to  try  this  method  in 
other  spasmodic  coughs  and  laryngeal  spasms." — (N.  Y.  Med- 
ical Record.) 

It  is  probable  that  by  drawing  the  jaw  down  and  forward 
the  suprahyoid  muscles  pull  upon  the  hyoid  bone,  stretching  all 
the  hyoid  muscles,  and  releasing  pressure  from  off  the  superior 
laryngeal  nerve,  which  passes  just  behind  the  greater  oornu, 
thus  relieving  the  irritation  of  the  nerve  and  the  consequent 
spasm  in  the  muscles,  especially  the  crico-thyroid. 

IXFLUEN7A. 

(LAGRIPPE — EPIDEMIC  CATARRHAL  FEVER.) 
CASES:     (1)  Four   cases   in    one   family   restored    to   usual 
health  within  a  week. 

(2)  Four  cases  cured  in  four  or  five  treatments,  no  bad  re- 
sults following  the  disease. 


376  PRACTICE    OF    OSTEOPATHY. 

(3)  Lagrippe,   attacking  the   throat  and   complicated   with 
a  severe  tonsillitis,  was  cured  by  several  treatments. 

(4)  A  severe  attack  of  lagrippe  cured  in  four  days  by  treat- 
ment directed  to  bowels,  kidneys,  and  splanchnic  nerves. 

(5)  A  list  of  thirty-five  cases,  one  of  which  had  been  cured 
by  one  treatment,   and  the  remaining   cases  cured  by   several 
treatments,  none  requiring  over  four. 

(6)  A  report  of  a  number  of  cases  of  lagrippe,  all  with  marked 
symptoms.     In  every  case  the  patient  was  able  to  be  up  in  from 
one  to  three  days.     No  complications  nor  sequelae  arose. 

(7)  A  lady  of  seventy-one  had  been   confined  to  her  bed 
for  two  weeks  with  lagrippe  and  rheumatism.     After  seven  treat- 
ments she  was  about,  the  lagrippe  being  cured  and  the  rheuma- 
tism much  improved. 

(8)  A  case  of  lagrippe  cured  in  four  treatments. 

LESIONS:  While  no  specific  bony  lesion  has  yet  been  men- 
tioned as  occurring  in  Influenza,  there  is  yet  a  specific  condition 
of  lesion  doubtless  closely  associated  with  the  invasion  of  the 
disease  into  the  system.  This  condition  is  a  general  contrac- 
turing  of  the  spinal  muscles,  most  marked  in  the  upper  dorsal 
and  cervical  regions,  but  affecting  the  whole  spinal  system. 
This  may  be  regarded  as  the  specific  lesion  in  influenza.  Dr. 
Still  regards  it  as  shutting  down  upon  the  whole  vascular  and 
nerve  system  of  the  body,  through  the  constricting  effect  of  these 
contractures  upon  the  spinal  nervous  system  through  its  pos- 
terior distribution.  The  result  is  a  sluggish  condition  of  all  the 
vital  fluids,  lymphatic,  blood  and  nerve. 

While  it  is  doubtless  true  that  the  bacillus  of  Pfeifer  is  the 
infecting  agent,  it  yet  remains  to  account  for  the  sudden  invasion 
of  the  system  by  this  germ,  since  it  is  known  that  the  germs  of 
disease  cannot  attack  healthy  tissues  and  that  a  body  in  perfect 
health  is  immune. 

In  this  connection  it  is  significant  that  debilitated  persons 
fall  the  easiest  victims  to  the  malady.  In  a  majority  of  such 
individuals  it  is  doubtless  true  that  various  osteopathic  lesions 
already  exist  and  so  weaken  the  system  in  one  way  or  another 
as  to  lay  it  liable  to  the  invasion  of  the  germ. 

Just  so,  the  general  muscular  contracture  found  as  the  char- 


PRACTICE    OF   OSTEOPATHY.  377 

.•acteristic  lesion  in  lagrippe,  acts  upon  the  vital  forces  of  the  sys- 
tem to  debilitate  them  and  lay  the  body  liable  to  invasion.  This 
theory  would  appear  entirely  reasonable  in  the  light  of  the  fact 
that  Pepper  thinks  it  likely  that  the  germ  exists  everywhere,  but 
depends  upon  certain  extraordinary  atmospheric  or  telluric 
conditions  for  occasion  to  break  out  into  virulence.  It  is  quite 
reasonable  to  hold  that  some  special  set  of  circumstances,  it  may 
•even  be  these  same  extraordinary  atmospheric  conditions,  re- 
:sults  in  these  spinal  contractures  which,  occurring  coincidentally 
with  the  periods  of  virulence  of  the  germ,  allow  of  the  invasion 
of  the  system. 

Lagrippe  is  most  frequent  in  bad  weather,  and  it  may  be 
that  then  exposure  to  cold  may  set  up  these  contractures.  While 
it  is  true  that  the  authorities  hold  the  disease  to  be  entirely  in- 
dependent of  climate  and  season,  it  is  yet  true  that  a  person  may 
'"catch  cold",  at  any  time  and  place,  these  contractures  being 
•well  known  to  result. 

It  is  probable  that  the  presence  of  various  lesions,  bony 
and  otherwise,  in  the  body,  determines  the  disease  to  a  special 
part  of  the  system,  resulting  in  the  peculiar  manifestation  of  the 
•disease  which  distinguishes  it  as  the  abdominal  type,  the  cere- 
bral type,  the  thoracic  type,  etc. 

Probably,  too,  such  lesions  are  responsible  for  the  various 
complications  and  sequelae  which  constitute  so  marked  a  feature 
•of  the  attack,  as  affections  of  lungs,  heart  and  nervous  system. 

The  PROGNOSIS  under  osteopathic  treatment  is  particu- 
larly good,  one  or  a  few  treatments  being  usually  all  necessary 
in  uncomplicated  cases.  When  the  case  is  taken  in  time  com- 
plications do  not  ensue.  If  present  they  are  usually  readily 
overcome  by  the  treatment.  It  is  a  well  known  fact  that 
the  mortality  in  influenza  is  due  chiefly  to  its  complications, 
consequently  not  the  least  satisfactory  result  of  osteopathic 
treatment  is  in  overcoming  danger  of  these.  The  distressing 
•sequelae,  especially  affecting  lungs,  nervous  system,  and  eyes 
and  ears,  do  not  occur. 

The  TREATMENT  indicated  is  a  thorough  general  one,  as 
-for  a  bad  cold,  including  particularly  the  complete  relaxation 
of  all  the  spinal  tissues,  thus  restoring  the  equilibrium  of  the 


378  PRACTICE  OF  OSTEOPATHY. 

vascular  and  nervous  system.  This  object  accomplished,  a  long 
step  toward  recovery  has  been  taken. 

During  this  process  occasion  is  taken  to  strongly  stimulate 
heart  and  lungs,  regulating  circulation,  sweeping  out  congestions, 
inducing  perspiration  and  lessening  fever,  and  sustaining  these 
organs  themselves  against  the  effects  the  disease  is  likely  to  pro- 
duce in  them.  This  treatment  embodies  raising  the  clavicle  and 
ribs,  work  over  the  chest  anteriorly,  stimulation  of  the  vaso- 
motor  and  accelerator  innervation  in  the  upper  dorsal  region, 
etc.,  all  described  in  considering  the  diseases  of  heart  and  lungs. 

The  liver,  kidneys,  bowels  and  fascia  are  likewise  kept  well 
stimulated. 

It  is  well,  especially  in  the  iheumatoid  type,  to  carry  the 
relaxing  treatment  over  all  parts  of  the  body,  flexing  and  rotating 
the  thighs,  working  about  the  shoulders,  upper  limbs,  neck.  etc. 
This  overcomes  the  distressing  general  aching  and  soreness  in 
the  muscles. 

Careful  abdominal  treatment  is  called  for,  particularly  if 
the  disease  shows  a  tendency  to  settle  in  that  region.  Work 
upon  the  liver,  bowels,  solar  and  hypogastric  plexuses,  and 
splanchnics  in  the  usual  way  will  meet  these  requirements. 

The  general  spinal  and  cervical  treatment  both  aids  the 
general  effect  and  provides  against  affection  of  the  central  nervous 
system,  brain,  and  organs  of  special  sense. 

The  general  health  must  be  carefully  guarded,  the  patient 
must  be  kept  from  exposure,  be  prevented  from  going  out  too 
soon,  and  be  kept  upon  a  light  nutritious  diet.  This  should  be 
largely  fluid  in  case  the  patient  is  confined  any  length  of  time  to 
his  bed. 

The  fe^ffcr,  headache,  pains  in  the  eye-balls,  and  other  man- 
ifestations of  the  disease  are  treated  specially  in  the  usual  ways. 

MALARIA. 

Malaria  is  a  disease  which,  although  due  to  the  activities 
of  a  specific  germ,  the  hematozoon  of  Leveran,  yet  presents 
marked  bony  lesions,  which  account  for  the  manifestations  of 
the  germ  within  the  system. 

The  LESIONS  are  mostly  in  the  splanchnic  area,  disturbing 


PRACTICE  OF  OSTEOPATHY.  379 

the  sympathetic  and  vaso-motor  innervation  of  liver,  spleen  and 
kidneys.  McConnell  notes  lesion  as  a  marked  lateral  deviation 
at  the  9th  and  1th  dorsal  vertebrae,  and  a  resulting  downward 
luxation  of  the  10th  rib,  also  lesion  of  the  9th  to  llth  dorsal  ver- 
tebrse  or  in  the  corresponding  ribs. 

Dr.  Still  points  out  lesion  at  the  first  lumbar,  at  the  sacrum, 
at  the  splanchnics,  and  in  the  cervical  region. 

These  various  bony  lesions  must  produce  a  marked  effect 
upon  the  sympathetic  system,  resulting  in  vaso-motor  disturb- 
ance. 

The  PROGNOSIS  is  good.  Dr.  Still  says  that  he  never  needs 
to  give  a  patient  a  second  treatment.  Usually  a  few  treatments 
overcome  the  difficulty,  and  quick  results  are  often  shown.  Yet 
it  often  happens  that  but  slow  progress  is  made.  Complica- 
tions, however,  are  prohibited  by  the  treatment.  Marked  re- 
lief is  at  once  given  during  the  paroxysm. 

The  TREATMENT  is  directed  particularly  to  the  splanchnic 
area,  and  to  opening  of  the  abdominal  blood-supply.  By  the 
splanchnic  and  abdominal  treatment,  liver,  kidneys,  spleen,  and 
bowels  are  kept  in  an  active  state.  This  is  the  chief  object  of 
the  treatment. 

Treatment  is  given  at  any  time,  during  or  between  the  par- 
oxysms. 

The  specific  treatment  employed  by  Dr.  Still  in  cases  of 
malaria  is  as  follows:  With  the  patient  sitting  facing  him,  he 
passes  his  arms  beneath  the  axillae  and  grasps  the  spine  with 
both  hands,  one  on  either  side  of  the  spinous  process,  at  the 
fourth  dorsal  vertebra.  He  now  draws  the  patient's  body  to- 
ward him,  though  not  moving  the  patient  from  his  position  on 
the  chair,  thus  stretching  the  spine  and  bringing  pressure  upon 
the  4th  vertebra.  He  closes  this  manoeuver  by  twisting  or  ro- 
tating the  trunk  slightly,  first  to  one  side  and  then  to  the  other, 
all  the  time  continuing  the  pressure  at  the  vertebra.  This  simple 
process  is  repeated  at  the  12th  dorsal  for  the  renal  splanchnic. 
In  this  way  the  splanchnic  and  renal  splanchnics  are  stimulated. 

He  concludes  the  treatment  by  momentarily  bringing  pres- 
sure with  his  thumbs  down  upon  the  femoral  arteries.  The 
time  of  this  pressure  is  merely  long  enough  to  allow  one  heart- 


380  PRACTICE   OF   OSTEOPATHY. 

t»eat  to  elapse.  His  idea  is  that  this  momentary  damming  back 
of  the  femoral  currents  upon  the  heart  causes  it  to  give  a  sudden 
strong  beat  to  overcome  the  resistance,  rousing  it  to  activity 
and  stimulating  the  system. 

A  general  spinal,  cervical,  and  stimulative  treatment  to 
heart  and  lungs  may  be  given  for  the  chill.  This  overcomes 
the  intense  vaso-motor  constriction  of  the  surface  of  the  body, 
collateral  with  an  inward  congestion,  and  equalizes  the  circula- 
tion. The  abdominal  treatment  aids  this  process. 

This  general  treatment  likewise  aids  in  taking  down  the 
fever.  The  more  specific  treatment  may  be  given  as  indicated, 
in  the  cervical  region,  upon  the  chief  vaso-motors,  and  vaso- 
motor  center  of  the  medulla,  via  the  superior  cervical  ganglion. 

No  specific  treatment  is  called  for  to  allay  the  sweating, 
.as  this  is  itself  a  relief  to  the  patient's  condition.  The  general 
method  of  treatment  described  may  be  properly  applied  during 
this  stage  or  during  the  intermission. 

TYPHOID  FEVER. 

CASES:  (1)  A 'case  taken  in  the  usual  way"  and  presenting 
the  usual  symptoms.  The  fever  was  103  degrees  at  4  p.  m., 
when  the  osteopath  was  called.  The  next  morning  the  fever 
was  below  102  degrees,  rising  that  evening  to  103.5  degrees.  On 
the  succeeding  evening  it  was  again  103.5  degrees,  but 
this  was  the  highest  point  reached.  Thereafter,  instead  of  the 
temperature  remaining  about  104  degrees  for  two  wreeks,  as  is 
typical,  the  gradual  decent  began  immediately  and  in  two  weeks 
the  patient  was  well.  As  early  as  five  days  after  treatment  began 
most  of  the  symptoms  had  disappeared. 

(2)  This  case  when  first  seen,  had  a  pulse  of  102,  a  tem- 
perature of  105  degrees,  and  all  the  usual  symptoms  marked, 
even  delirium  being  present,  and  the  stools  and  urine  passing 
involuntarily.     He  had  been  ill  with  the  fever  for  two  weeks. 
Gradual   decent   of   the   temperature   began   immediately   upon 
treatment.     It  became  normal  seventeen  days  after  treatment 
began.     The  symptoms  began  to  abate  with  the  fever,  all  but 
the  weakness  having  disappeared  in  twelve  days. 

(3)  A  case  seen  on  the  day  after  it  had  taken  to  bed,  with 


PRACTICE    OF    OSTEOPATHY.  381 

a  temperature  of  101  degrees.  In  two  days  the  symptoms  began 
to  abate.  On  the  fourtli  day  the  fever  had  risen  to  104  degrees, 
falling,  then  rising  on  the  seventh  day  to  104  degrees  again. 
After  this  there  was  a  gradual  descent,  until  on  the  evening  of  the 
twenty-fifth  day  the  temperature  was  normal.  The  usual  per- 
iod of  high  temperature  had  thus  been  prevented. 

(4)  In  a  girl  of  nine,  who  had  suffered  from  typhoid  fever, 
the  lingering  effects  of  the  disease,  suffered  from  five  years  before, 
were  very  marked.  The  difficulty  took  the  form  of  acute  at- 
tacks commencing  with  pain  in  the  eyes,  followed  by  intense 
headache  and  delirium,  and  a  rash  upon  the  skin.  As  the  rash 
disappeared,  swelling  and  pain  in  the  joints  would  follow.  These 
attacks  would  recur  about  every  two  weeks.  The  child  was 
emaciated  and  suffered  from  involuntary  micturition.  She  had 
been  under  skilled  medical  care,  and  the  case  had  attracted  such 
attention  that  it  was  discussed  before  a  convention  of  physicians 
in  Denver. 

Being  treated  osteopathically  during  an  attack,  she  recovered 
at  this  time  without  the  usual  swelling  and  rheumatic  symptoms. 
After  two  months  treatment  the  case  was  discharged  cured. 

The  only  bony  lesion  was  a  lateral  luxation  of  the  third 
cervical  vertebra,  but  all  of  the  spinal  muscles  were  intensely 
contractured. 

These  few  cases  are  quite  typical  of  the  many  treated. 

LESIONS:  Dr.  Still  describes,  as  the  charactesistic  "ty- 
phoid spine,"  a  posterior  prominence  of  the  lower  lumbar  region, 
caused  by  a  backward  displacement  of  the  3rd,  4th,  and  5th 
lumbar  vertebrae.  He  holds  that  the  result  produced  by  these 
lesions  is  a  paralysis  of  the  lymphatic  supply  of  the  bowels,  by 
pressure  upon  the  spinal  nerves  at  their  exit  from  the  interverte- 
bral  foramina.  Thus  is  produced  the  essential  typhoid-  condi- 
tion of  the  small  intestine  characteristic  of  the  disease. 

He  notes  also  lesions  along  the  upper  dorsal  region,  at  which 
point  he  makes  treatment  upon  the  lungs,  correcting  the  activ- 
ities of  the  lymphatics  system,  thus,  as  he  says,  making  water 
to  put  out  the  fire  of  the  fever. 

In  general  the  lesions  found  in  typhoid  fever  are  rib,  ver- 
tebral and  muscular  lesions  affecting  the  splanchnic  and  him- 


382  PRACTICE    OF   OSTEOPATHY. 

bar  regions  of  the  spine,  irritating  spinal  nerves,  and  through 
them  disturbing  the  sympathetic,  vaso-motor,  and  lymphatic 
supply  of  the  small  intestines. 

As  before  pointed  out  in  detail  (see  diseases  of  stomach 
and  intestines),  these  portions  of  the  spine  suffering  from  lesion 
give  origin  to  the  visceral  nerves  of  the  intestines.  The  vaso- 
motor  supply  of  the  abdominal  vessels,  according  to  Quain,-  is 
from  the  splanchnic  and  lumbar  portion  of  the  cord. 

These  include  the  vaso-motors  of  the  jejunum  and  ileum, 
the  seat  of  ulceration  in  the  disease. 

Pathologically,  the  process  in  the  first  two  stages  of  typhoid, 
infiltration  and  necrosis  of  the  patches,  is  regarded  as  a  vaso- 
motor  disturbance.  The  first  stage  is  an  intense  inflammation, 
involving  to  a  greater  or  less  degree  the  whole  mucosa.  The 
second  stage  is  the  result  of  an  obstructed  circulation  to  the  parts 
of  the  intestine  involved.  In  view  of  these  facts  it  is  evident 
that  successful  therapeutic  measures  must  gain  vaso-niotor 
control.  It  is  an  indication  to  the  Osteopath  that  he  must  do 
spinal  work  upon  the  vaso-motor  area  supplying  the  bowels,  re- 
moving the  lesion  'that  is  obstructing  the  natural  play  of  the 
forces  necessary  to  health. 

The  PROGNOSIS  is  good,  yet  one  must  not  forget  to  be  upon 
his  guard,  constantly,  against  the  complicatiQns  and  intercurrent 
maladies  that  so  often  carry  off  the  typhoid  patient.  Under 
osteopathic  treatment,  however,  complications  and  sequelse  are 
quite  prevented.  Indeed,  much  fine  osteopathic  work  has  been 
done  upon  paralytic  and  various  other  forms  of  the  sequelse  fol- 
lowing an  attack  of  typhoid  fever. 

If  taken  within  a  week  or  ten  days  the  course  can  be  usually 
aborted  to  a  marked  degree.  Often  cases  gotten  early  have  had 
their  course  terminated  within  a  few  days.  Bad  cases,  taken 
under  treatment  after  so  late  as  the  fourteenth  day,  commonly 
at  once  show  marked  improvement. 

The  characteristic  course  of  the  temperature  is  entirely 
changed.  It  is  usual  to  notice,  no  matter  in  what  stage  the  case 
may  be  when  it  comes  under  the  treatment,  that  the  temperature 
begins  at  once  to  gradually  decline.  When  the  case  is  taken 


PRACTICE    OF    OSTEOPATHY.  383 

before  the  second  week,  the  usual  period  of  high  temperature  i? 
prevented. 

TREATMENT:  The  main  object  of  the  treatment,  as  pointed 
out,  is  to  gain  vaso-motor  control  of  the  intestinal  blood-supply, 
and  to  restore  intestinal  lymphatics  to  normal  activity.  Con- 
sequently the  main  treatment  in  these  cases  is  spinal.  It  must 
be  devoted  particularly  to  the  correction  of  the  mal-positions 
of  the  3rd,  4th  and  5th  lumbar  as  described  above,  and  to  the 
removal  of  any  spinal,  muscular,  rib,  or  vertebral  lesion  present. 

Most  of  the  treatment  in  these  cases  must  be  done  upon  the 
spine,  leaving  the  abdomen  almost  entirely  free  from  manipula- 
tion. 

All  the  spinal  muscles  should  be  relaxed,  this,  with  a  careful 
cervical  treatment,  quieting  the  nervous  system,  and  relieving 
the  jerking  of  the  subsultus  tendinum.  This  treatment  is  care- 
fully made  while  the  patient  is  lying  upon  one  side.  The  patient 
must  not  be  moved  into  various  positions  any  more  than  can  be 
avoided.  It  is  important  to  avoid  fatiguing  him. 

Lungs  and  heart  should  be  kept  gently  stimulated  by  work 
in  the  usual  place  in  the  upper  dorsal.  This  aids  in  keeping  up 
the  patient's  strength  and  in  preventing  complicating  diseases 
of  these  organs.  Treatment  at  the  renal  splanchnics  should  be 
given  to  keep  the  kidneys  active. 

The  main  treatment  being  along  the  splanchnic  and  lumbar 
regions,  these  portions  of  the  spine  are  treated  by  careful  relax- 
ation of  all  contractures,  by  gently  springing  the  spine  for  the 
relaxation  of  ligaments  and  for  the  freedom  of  the  nerves,  and  in 
removing  the  bony  lesions  mentioned. 

The  correction  of  the  lesion  to  3rd,  4th  and  5th  lumbar 
controls  the  diarrhoea.  It  may  be  treated  in  the  usual  way. 

The  spleen  and  liver  are  reached  by  spinal  work  at  their  in- 
nervation. 

The  abdominal  treatment  is  almost  nil.  Any  manipula- 
tion made  here  should  be  with  extreme  gentleness.  It  is  best 
to  confine  this  treatment  to  the  iliac  regions,  raising  the  intes- 
tines slightly,  with  the  idea  of  straightening  them  in  the  iliac 
fossse.  (IV.  Chap.  VIII.) 

The  fever  is  treated  by  work  at  the  superior  cervical  ganglion 


384  PRACTICE  OF  OSTEOPATHY. 

in  the  usual  way,  thus  regulating  the  systemic  circulation  by 
affecting  the  general  vaso-motor  center  in  the  medulla.  The 
treatment  to  the  heart  and  lungs  aids  this  process  by  equalizing 
the  circulation,  as  does  also  the  general  spinal  work  and  the 
treatment  given  along  the  spine  for  intestinal  circulation  specific- 
ally. The  heart  beat  should  be  slowed  by  inhibition  at  the  2nd 
to  5th  dorsal,  on  the  left. 

In  case  of  rapid  beating  of  the  heart,  persisting  sometimes 
for  a  long  period,  Dr.  Hildreth  finds  that  correction  of  the  left 
5th  rib  gives  relief. 

The  hiccough  is  treated  in  the  usual  way. 

In  case  of  hemorrhage  the  patient  should  be  kept  perfectly 
quiet,  have  no  solid  food,  and  an  ice-bag  should  be  applied  over 
the  caecum.  The  foot  of  the  bed  should  be  elevated.  Inhibition 
of  peristalsis  should  be  done  by  work  from  the  9th  dorsal  down 
along  the  lumbar  region. 

In  case  of  perforation,  hot  applications,  or  the  ice-bag,  are 
applied  to  the  abdomen  to  relieve  the  patient. 

The  usual  precautions  should  be  taken  for  the  hygiene  of 
the  sick  room,  the  disinfection  of  the  linen,  the  sterilizing  of  the 
stools  and  urine,  and  general  cleanliness. 

The  patient's  body,  a  part  at  a  time,  should  be  sponged 
with  tepid  water  daily.  The  Brand  system  of  baths  is  much 
usejl  at  the  present  day. 

In  regard  to  diet  the  usual  observance  of  "a  strictly  liquid 
diet  is  followed.  Some  are  using  light,  easily  digested  food  the 
first  week  or  ten  days,  until  danger  of  perforation  has  arrived. 
The  claim  is  made  that  the  patient's  strength  is  in  this  way  much 
better  preserved.  It  would  be  safe  for  an  Osteopath  to  carry 
a  case  through  on  such  a  diet  providing  he  got  it  early  enough 
to  prevent  the  danger  of  perforation. 

After  first  taken  the  patient  should  not  be  allowed  to  get 
up  from  his  bed.  A  bed-pan  and  urinal  should  be  used. 

During  convalescence  the  patient's  condition  should  be 
carefully  watched.  The  return  to  a  hearty  diet  should  be  grad- 
ual in  spite  of  his  great  appetite.  After  a  liquid  diet  the  semi- 
solid  food  should  not  be  allowed  until  the  temperature  has  been 
normal  a  week. 


PRACTICE    OF    OSTEOPATHY.  385 

ERYSIPELAS. 

(St.  Anthony's  Fire,  "The  Rose.") 

Erysipelas  is  a  disease  frequently  treated  and  cured  osteo- 
pathically.  The  PROGNOSIS  is  good. 

The  LESIONS  are  various  forms  of  obstruction  to  the  cir- 
culation of  the  part  affected.  The  lesion  may  be  bony,  or  a 
contracture  of  muscles  or  other  tissues.  It  may  directly  press 
upon  veins  and  lymphatic  vessels,  preventing  the  proper  drain- 
age of  the  part,  or  it  may  derange  the  vaso-motor  innervation 
and  the  sympathetic  innervation  of  the  lymphatics.  For  ex- 
ample, a  case  of  erysipelas  in  a  lower  limb  was  cured  by  turning 
the  head  of  the  femur  well  in  the  socket,  and  in  raising  the  ab- 
dominal viscera  up  from  the  region  of  the  crural  arch,  where  they 
were  pressing  upon  the  blood-vessels  and  preventing  drainage 
from  the  limb  through  femoral  vein  and  lymphatics.  By  thus 
relaxing  the  tissues  and  removing  direct  impingement  from  the 
vessels,  the  blood-flow  was  restored  and  the  case  was  cured. 

Another  case  in  which  the  eruption  appeared  upon  the  face, 
was  cured  by  springing  the  temporo-maxillary  articulation  with 
the  assistance  of  corks  placed  between  the  molar  teeth,  as  one 
would  set  a  dislocated  jaw.  In  this  way  various  tissues  about 
the  jaw  may  have  been  relaxed,  or  impingement,  of  the  fibers  of 
the  fifth  nerve  removed,  restoring  circulation. 

The  most  usual  lesions  in  erysipelas  are  found  preventing 
the  circulation  from  the  head,  as  the  face  is  the  part  most  fre- 
quently attacked.  Lesions  of  cervical  vertebrae  and  muscles 
affect  the  vaso-motors  and  sympathetics  regulating  the  blood 
and  lymphatic  circulation  of  the  face,  and  lead  to  inflammation 
by  obstructing  these  fluids,  the  specific  germ  being  present  and 
attacking  the  part  thus  rendered  liable  to  its  action.  Clavicle 
and  first  rib  lesions  may  directly  obstruct  the  jugular  veins  and 
the  cervical  lymphatics,  leading  to  the  same  result. 

McConnell  notes  lesion  of  the  2nd,  3rd,  4th  and  5th  dorsal 
vertebrae,  and  of  corresponding  ribs  and  surrounding  muscles, 
causing  erysipelas  in  the  face,  by  disturbing  sympathetic  inner- 
vation. 

The  TREATMENT  is  simple,  calling  for  removal  of  lesion  and 

25 


386  PRACTICE   OF   OSTEOPATHY. 

re-establishment  of  venous  and  lymphatic  drainage  of  the  affected 
part.  This  involves  relaxation  of  muscles  and  other  tissues, 
restoration  of  bony  parts  to  position,  freeing  of  nerve  connec- 
tions, etc.,  as  already  pointed  out,  according  to  the  part  affected. 

It  is  not  necessary  to  manipulate  the  inflamed  part. 

As  erysipelas  is  a  dermatitis,  the  need  of  gaining  vaso-motor 
control  is  apparent.  The  special  treatment  of  the  neck  to  affect 
free  circulation  to  and  from  the  head  and  face  has  been  sufficiently 
discussed  in  the  treatment  of  diphtheria  and  of  the  eruptive 
fevers. 

A  general  spinal  treatment  must  be  given  to  strengthen 
the  general  nervous  system  against  the  various  nervous  com- 
plications and  sequelae  that  may  arise,  such  as  delirium,  coma, 
subsultus  tendinum,  etc.  Bowels  must  be  kept  free,  and  liver 
and  kidneys  kept  active  to  get  rid  of  the  poison  of  the  disease 
which  is  deranging  the  constitutional  condition.  The  kidneys 
must  be  especially  supported  against  albuminuria  and  uremia. 

Among  the  hygienic  measures  and  domestic  remedies  rec- 
ommended are  isolation  of  the  patient,  drinking  plenty  of  cold 
water,  cold  spongings  of  the  part,  or  applications  of  iced  cloths, 
and  the  application  of  collodion  over  the  eruption.  Carbolized 
vaseline  may  be  used  to  anoint  the  affected  part. 

The  diet  is  important.  The  patient  should  be  liberally  fed 
on  a  light,  nutritious  diet.  Anders  states  that  liberal  feeding 
of  the  patient  is  of  greater  service  to  the  patient  than  any  of  the 
recognized  forms  of  medicinal  treatment,  and  the  lack  of  atten- 
tion to  the  diet  during  the  primary  attacks  tends  to  increase  the 
frequency  of  relapse. 

MEASLES. 
(MORBILLI,  RUBEOLA). 

Very  numerous  cases  have  been  successfully  treated 
The  PROGNOSIS  is  good.     The  danger  of  complications  and 
sequlee  is  minimized,  as  these  cases  recover  quickly  and  thor- 
oughly under  the  treatment. 

While  it  is  held  that  measles,  once  started,  must  run  its 
course,  yet  the  period  of  convalescence  is  shortened  and  the 
child  is  about  earlier  without  danger  of  complications. 


PRACTICE    OP    OSTEOPATHY.  387 

LESIONS:  Dr.  Still  describes  in  this  disease  a  general  ."con- 
gestion of  the  lymphatic  drainage  of  the  skin  becoming  evident 
as  a  cutaneous  rash.  This  general  congestion  is  due  to  spinal 
muscular  contractures  all  along  the  spine,  irritating  the  spinal 
distribution  of  nerves,  and  through  them  deranging  sympathetic 
vaso-motor  and  lymphatic  nerve-supply. 

This  general  congestion  of  the  spinal  muscles  appears  as 
lesion  in  muscles.  The  clavicle  may  be  found  with  its  sternal 
end  displaced  backward  against  the  vagus  nerve,  causing  the 
cough,  and  aiding  to  cause  the  catarrhal  condition  of  the  bronchi. 
Upper  rib  lesions  may  be  found,  their  correction  relieving  the 
cough.  Weakened  children,  especially  those  presenting  upper 
spinal  arid  thoracic  rib  lesions,  are  apt  to  become  victims  of  pul- 
monary tuberculosis  after  measles.  The  clavicle  and  first  rib 
lesion,  as  well  as  various  cervical  bony  lesions  and  muscular  con- 
tractures, probably  account  for  complications  and  sequela  in 
eye,  ear,  nose  and  throat.  These  effects  come  largely  through 
obstructed  lymphatic  drainage  from  the  neck,  a  fact  well  illus- 
trated by  the  marked  enlargement  of  the  cervical  lymph  glands 
as  a  complication  or  sequel  of  the  disease. 

In  the  TREATMENT  the  first  step,  especially  if  the  rash  has 
not  developed,  is  a  thorough  stimulation  of  the  cutaneous  sys- 
tem, including  a  general  spinal  treatment,  with  particular  at- 
tention to  atlas  and  axis,  for  effect  upon  the  vaso-motor  center 
in  the  medulla;  upon  the  second  dorsal  and  fifth  lumbar,  cutan- 
eous centers.  In  tardy  cases  one  such  treatment  suffices  to  bring 
out  the  rash  abundantly,  a  desirable  result,  since  upon  its  ap- 
pearance the  headache  and  fever  disappear,  and  the  patient  feels 
better. 

This  treatment  would  include  a  general  relaxation  of  the 
spinal  muscles,  correcting  the  lymphatic  obstruction. 

An  important  effect  of  the  general  spinal  and  cervical  treat- 
ment, together  with  some  special  treatment  to  heart  and  lungs, 
is  to  correct  the  general  circulation,  calling  away  from  all  the 
viscera  the  abnormal  amount  of  blood  retained  in  them  as  a  con- 
gestion, in  this  disease.  For  this  purpose  there  should  be  added 
treatment  of  the  splanchnics,  solar  plexus,"  liver,  kidneys,  and 
abdominal  circulation  generally. 


388  PRACTICE    OF    OSTEOPATHY. 

The  usual  treatment  of  the  throat,  internal  and  external; 
of  the  neck;  of  clavicle  and  first  rib;  of  the  upper  anterior  chest, 
raising  the  ribs,  and  working  in  the  anterior  intercostal  spaces 
against  the  costal  cartilages;  and  of  the  face  and  nose,  should  be 
given  to  overcome  the  catarrhal  condition  of  the  respiratory 
tract,  just  as  a  cold  and  a  bronchitis  are  treated. 

The  lungs  should  be  kept  well  supported  by  the  treatment, 
to  avoid  the  danger  of  bronchitis  and  pneumonia.  Likewise 
kidneys,  eye,  ear,  nose,  and  throat  should  be  guarded  against 
effects  in  them. 

The  cough  is  relieved  by  relaxing  the  throat  tissues,  treat- 
ment along  the  larvnx  and  trachea,  correction  of  first  rib  and 
clavicle,  and  raising  of  the  upper  ribs. 

The  patient  should  remain  in  bed  until  desquamation  is 
well  along,  should  be  in  a  darkened  room  for  the  sake  of  the 
eyes,  and  should  be  kept  upon  a  light  diet  of  milk,  bread,  light 
soups,  etc. 

The  general  spinal  treatment,  and  treatment  of  the  cutane- 
ous system  and  centers,  will  aid  in  allaying  the  itching  of  the 
skin.  For  this  purpose,  also  a  daily  warm  bath  may  be  given. 

RUBELLA. 

(FRENCH  OR  GERMAN  MEASLES.) 

VARICELLA. 

(CHICKENPOX.) 

To  these  conditions  we  may  apply  the  same  general  remarks 
concerning  lesions  and  treatment,  osteopathically,  as  made  in 
considering  measles. 

The  very  mild  symptoms  accompanying  these  conditions 
call  for  but  little  treatment  aside  from  the  general  constitutional 
one,  pointed  out  in  detail  in  measles.  These  points  of  treatment 
may  be  applied  as  necessary. 

Due  attention  must  be  given  to  avoid  exposure,  the  clan- 
gers of  complications,  etc.  In  rubella  the  enlargement  of  the 
cervical  lymphatics  calls  for  attention  in  the  manner  pointed  out. 
The  slight  fever  and  catarrhal  symptoms  are  readily  overcome. 
In  both  conditions  due  attention  must  be  given  to  the  cervical 


PRACTICE    OF   OSTEOPATHY.  389 

and  general  spinal  treatment,  and  to  the  maintenance  of  the 
activities  of  the  various  viscera.  Usually  the  spinal  muscles  are 
contractured,  and  must  be  relaxed.  These  contractures  doubt- 
less affect  the  general  lymphatic  system  by  way  of  the  spinal 
nerves.  For  example,  in  varicella  the  superficial  lymph  glands 
are  sometimes  visibly  enlarged. 

In  varicella  the  usual  precaution  of  preventing  the  child's 
scratching  off  the  scabs  by  putting  mittens  or  bandages  upon 
the  hand  and  wrists,'  and  of  painting  the  scab  over  with  collo- 
dion may  be  observed. 

SCARLET  FEVER. 

(SCARLATINA.) 

•  Numerous  cases  have  been  successfully  treated  osteopath- 
ically.  The  PROGNOSIS  is  good,  but  must  be  guarded  in  cases  com- 
plicated with  diphtheria.  The  experience  is  to  bring  these  cases 
safely  through  the  attack,  free  from  complications  and  sequelae. 

The  LESIONS  are,  in  general,  the  same  as  described  for  the 
various  acute,  specific  fevers.  Contractured  spinal  and  cer- 
vical muscles  are  noted.  One  must  expect  various  bony  lesions, 
accounting  for  the  weakness  of  the  special  parts  attacked  by 
complications  or  sequelae,  as  for  the  kidneys,  throat,  and  general 
nervous  system  by  the  usual  bony  lesions  found  present  in  dis- 
eases of  these  parts. 

The  TREATMENT  proceeds  along  the  lines  already  laid  down. 
In  this  case  there  is  especial  need  of  thorough  constitutional 
treatment  on  account  of  the  multiplicity  of  symptoms  and  the 
variety  of  organs  sometimes  affected. 

The  general  spinal  treatment  is  given,  relaxing  muscles, 
stimulating  the  splanchnics,  etc.  Particular  attention  must 
be  given  to  lesions  affecting  the  kidneys,  and  to  the  thorough 
treatment  of  the  innervation  of  them,  throughout  the  course 
of  the  disease,  for  the  purpose  of  avoiding  the  post-scarlatinal 
nephritis,  so  common  a  complication. 

For  a  like  reason  one  must  give  especial  attention  to  the 
treatment  of  the  throat  to  avoid  diphtheria. 

The  cervical  treatment  must  be  carefully  carried  out.  The 
marked  enlargement  of  the  lymphatic  glands  that  sometimes 


390  PRACTICE    OF    OSTEOPATHY. 

occurs  may  be  avoided  or  controlled  by  the  usual  treatment. 
Relaxation  of  all  the  anterior  and  posterior  muscles,  etc.,  must 
be  done.  This  treatment  frees  the  lymphatic  and  blood-circu- 
lation through  the  neck,  and  keeps  eye,  ear,  and  throat  in  good 
condition. 

The  heart  must  be  kept  well  supported.  The  fever  is  treated 
in  the  usual  way.  When  the  patient's  system  is  kept  well  sup- 
plied with  moisture  by  allowing  him  a  plentiful  supply  of  cold 
water,  daily  treatment  of  the  sub-maxillary  salivary  glands  will 
aid  in  keeping  the  mouth  and  lips  moist. 

The  irritation  of  the  skin  may  be  relieved  by  the  treatment 
indicated  for  that  purpose  in  measles.  Daily  tepid  sponging 
and  warm  bathing,  as  well  as  anointing  of  the  skin  with  an  animal 
fat  or  cocoa  butter,  are  useful  for  this  purpose. 

The  patient  should  be  isolated,  the  scales  shed  in  desqua- 
mation  should  be  carefully  collected  and  burned,  and  the  room 
should  be  disinfected,  after  convalescence.  The  diet  should  be 
light.  Plenty  of  milk  and  alkaline  water  may  be  used. 

•VARIOLA  (Small-Pox.) 

It  is  at  present  impossible  to  say  anything  specific  with 
regard  to  treatment  of  small-pox  by  osteopathic  methods.  It 
is  doubtful  whether  the  disease,  in  any  marked  form,  has  ever 
been  treated  osteopathically.  Numerous  light  cases  have 
been  treated.  It  would  have  to  be  met  upon  the  same 
general  plan  as  other  fevers,  with  particular  attention  to 
the  special  clinical  manifestations  of  the  disease.  An  Osteo- 
path should  follow  the  same  precautions  with  regard  to  isola- 
tion, disinfection,  and  antisepsis  as  are  followed  by  any  other 
physician.  The  usual  osteopathic  procedure  would  be  followed 
in  the  treatment  of  muscular  pains,  vomiting,  diarrhoea,  convul- 
sions, etc.  The  ordinary  method  of  preventing  pitting  by  keep- 
ing the  face  washed  with  a  carbolic  or  mercuric-chlorid  solution 
and  covered  with  clean  cloths  saturated  with  warm  water,  and 
of  protecting  the  eyes  by  keeping  them  covered  by  cloths  wet  in 
a  boric  acid  solution,  and  by  darkening  the  room,  could  probably 
not  be  improved  upon  by  the  Osteopath.  He  should  see  that  the 
patient  is  well  bathed,  that  the  diet  is  carefully  regulated,  and 


PRACTICE    OF    OSTEOPATHY.  391 

should  meet  the  various  manifestations  of  the  condition  by  the 
usual  osteopathic  methods. 

CEREBRO-SPINAL  FEVER. 

(Epidemic   Cerebro-Spinal   Meningitis,   Spotted   Fever.) 

This  condition  has  been  successfully  treated  osteopathic- 
ally.  It  should  be  treated  upon  the  plan  followed  in  the  other 
forms  of  meningitis,  and  also  in  the  treatment  of  various  fevers, 
as  described.  It  is  necessary  to  be  especially  persistent  in  the 
local  treatment  to  the  spine  and  cervical  regions,  on  account  of 
the  marked  effects  of  the  disease  upon  the  cord.  Continual  treat- 
ment in  these  regions  is  a  most  valuable  aid  in  keeping  the  cir- 
culation equalized  and  in  lessening  the  inflammatory  processes 
going  on  about  the  cord.  It  should  be  mostly  of  a  relaxing, 
inhibitive  sort,  with  much  direct  inhibition  in  the  superior  cer- 
vical region  and  along  the  splanchnic  and  lumbar  regions.  The 
spinal  column  should  be  carefully  sprung,  held,  and  relaxed. 
The  painful  and  contractured  muscles  along  the  neck  and  back 
(opisthotonos)  must  be  continually  and  gently  relaxed.  This 
spinal  treatment  is  aided  by  the  abdominal  treatment,  as  before 
described,  given  for  the  purpose  of  drawing  the  blood  to  this 
region,  away  from  the  cord.  This  whole  process  of  treatment 
lessens  the  inflammatory  process  in  the  meninges,  aids  in  absorb- 
ing the  effused  serum,  and  the  fibrino-purulent  exudate,  and 
aborts  the  progress  of  the  disease.  It  practically  prevents  the 
usual  sequelse  and  complications  met  in  this  disease. 

In  the  course  of  the  treatment  due  attention  should  be 
given  to  the  adjustment  of  various  spinal  vertebral  lesions  usually 
present.  The  heads  of  the  ribs  and  the  deep  tissues  should  be 
carefully  examined  for  lesion.  This  part  of  the  treatment  is 
quite  an  important  factor  in  gaining  complete  freedom  of  circu- 
lation, and  complete  removal  of  irritation. 

The  remainder  of  the  treatment  is  largely  for  the  relief  of 
the  various  manifestations  of  the  condition.  One  should  follow 
the  directions  before  given  for  treatment  of  the  fever,  vomiting, 
constipation  or  diarrhoea,  occipital  headache,  etc.  For  the  sud- 
den violent  pains  one  should  use  inhibition  at  various  points 
along  the  spine  and  at  the  local  plexuses  and  nerves.  Sueh 


392  PRACTICE    OF    OSTEOPATHY. 

treatment,  well  applied,  together  with  the  spinal  treatment,, 
would  reach  the  convulsions  if  they  occur. 

It  is  well  to  give  particular  stimulating  treatment  to  the 
kidneys,  not  only  because  the  urine  is  scant  and  shows  the  usual 
febrile  characters,  but  also  because  of  the  toxaemia  due  to  the 
disease,  and  because  of  the  tendency  of  nephritis  to  appear  as  a 
complication. 

Eyes,  lungs,  heart,  and  organs  of  special  sense  must  be  kept 
well  treated  to  avoid  danger  of  complications  or  sequels  affect- 
ing them. 

The  PROGNOSIS  must  be  guarded,  but  under  osteopathic 
treatment  the  best  of  results  may  be  expected. 

DYSENTERY  (Bloody  Flux.) 

DEFINITION:  An  infectious  disease,  characterized  by  an 
inflammation  of  the  large  intestine,  frequent  mucous  and  bloody 
stools,  tormina,  tenesmus,  prostration  and  other  marked  symp- 
tioms.  It  is  due  to  specific  spinal  lesion. 

CASES:  (1)  Chronic  dysentery  of  five  years  standing,  in 
a  man  of  thirty-thre'e.  Lesions  were  a  posterior  condition  from 
the  llth  dorsal  to  3rd  lumbar.  The  case  was  cured  in  one  month 
of  treatment. 

(2)  A  case  of  acute  dysentery  of  two  days  standing.     Ail 
the  symptoms  were  marked.     The  case  was  much  relieved  by 
the  first  treatment,  the  bowels  did  not  move  until  twenty-four 
hours  after  it. 

(3)  A  severe  case  of  acute  dysentery  in  a  child.     It  was 
treated  two  days  and  the  stools  became  normal. 

(4)  A  case  of  chronic  dysentery  of  a  severe  nature,  in  a 
patient    suffering    with    paraplegia.     Lesions    were    an    anterior 
condition  of  the  5th  lumbar  vertebra,  a  lateral  swerve  of  the 
lower  dorsal  and  lumbar  region  of  the  spine,  and  luxation  of  the 
innominate  bones.     The  condition  was  cured  in  four  months. 

The  PROGNOSIS  is  good.  Treatment  is  usually  at  once 
successful  in  relieving  the  condition.  Many  cases  are  cured  in 
one  or  a  few  treatments,  even  though  they  are  chronic.  The 
worst  forms  of  dysentery  have  been  successfully  treated  after 
all  other  treatment  had  failed.  Generally  a  course  of  treatment 


PRACTICE    OF   OSTEOPATHY.  393 

is  advisable  in  order  to  fully  remove  lesion  and  to  restore  the  tis- 
sues of  the  bowel  to  their  normal  condition  by  a  corrected  circu- 
lation. 

The  LESIONS  and  the  TREATMENT  are  identical  with  those 
•described  for  diarrhoaa. 

PARASITES. 

Patients  suffering  from  the  presence  of  the  various  animal 
parasites  frequently  come  under  treatment.  The  common  round 
worm  (Ascaris  Lumbricoides) ;  the  pin-,thread-,  or  seat-worm 
(Oxyuris  Vermicularis) ;  the  hematozoon  of  malaria  (Hemato- 
aoon  of  Leveran) ;  and  the  several  forms  of  tape-worm  (Tsenia 
Solium,  T.  Latum,  T.  Saginata)  are  successfully  treated  osteo- 
pathically. 

No  particular  lesion,  of  course,  can  be  mentioned  in  this 
•connection.  Yet  commonly  in  these  cases  the  various  rib,  ver- 
tebral, and  other  lesions  affecting  the  bowels  are  present.  Their 
removal  is  related  to  the  cure  of  the  condition  as  a  part  of  the 
treatment  directed  to  securing  good  general  health,  and  free 
action  of  liver  and  of  bowels,  all  of  which  are  quite  important  in 
the  treatment  of  the  case. 

CASES:  (1)  Pin- worm  in  a  child  of  three  years,  of  several 
months  standing.  No  lesion  was  noted  except  a  downward 
position  of  the  lower  ribs.  Treatment  was  directed  to  raising 
the  lower  ribs,  to  stimulating  the  innervation  of  intestines  and 
liver,  and  to  direct  manipulation  of  these  organs.  No  local 
application  at  the  anus,  nor  enema  was  required  in  this  case. 
The  child  was  cured  by  10  treatments,  passing  forty-five  worms. 

(2)  A  case  of  pin- worms  in  a  child  suffering  with  poor  gen- 
eral health.     The  case  was  cured  in  two  months. 

(3)  A  case  of  tape-worm  in  a  woman  suffering  from  bad 
general  health.     The  liver  was  in  bad  condition.     The  treatment 
corrected  spinal  lesions  and  restored  liver  function  and  general 
health.     A   tape-worm   was   expelled.     The   case   was   well   one 
year  later. 

(4)  A  case  of  tape-worm  which  had  not  been  helped  by 
the  usual  medical  treatment.     The  liver  was  inactive,  and  le- 
sion was  found  as  a  lateral  swerve  of  the  spine  from  the  4th  to 


3!)4  PRACTICE    OF    OSTEOPATHY. 

the  8th  dorsal  vertebra.  The  treatment  was  particularly  to  the 
liver  and  the  spine.  The  worm  was  passed. 

TREATMENT  in  these  cases  is  directed  to  the  removal  of 
spinal  or  other  lesion;  the  restoration  of  a  healthy  condition  of 
the  bowel  and  general  digestive  apparatus;  the  stimulation  of 
hepatic  activity  particularly,  for  the  purpose  of  increasing  the 
flow  of  bile,  held  to  be  effective  in  expelling  the  worm;  and  the 
upbuilding  of  the  general  health.  This  treatment  applies  to  the 
general  case.  The  treatment  for  malaria  has  been  described 
elsewhere.  Its  success  demonstrates  the  ability  of  osteopathic 
treatment  to  clear  the  blood  of  the  protozoan  parasite  present 
in  it. 

In  cases  of  pin-worms  it  is  necessary  to  keep  the  parts  thor- 
oughly clean.  The  ova  are  killed  by  anointing  the  anus  with 
lard.  Injections  of  lard  into  the  rectum  will  kill  the  worms. 
Enemata  of  cold  water,  plain,  or  with  a  little  salt  or  soap  added, 
may  be  used  to  free  the  rectum.  The  child's  finger-nails  should 
be  kept  trimmed  and  well  cleaned  to  avoid  transfer  of  the  ova 
by  accumulating  under  them. 

The  rest  of  the  treatment  is  as  directed  above. 

In  case  of  round  or  tape-worms,  it  is  wrell  to  enforce  a  liquid, 
such  as  milk,  diet  for  a  day  or  two  in  order  to  weaken  the  worms 
and  to  leave  them  more  accessible  to  the  action  of  the  bile.  For 
tape-worm,  the  patient  should  then  drink  quantities  of  pumpkin- 
seed  infusion,  or  eat  a  gruel  made  of  mashed  pumpkin-seed,  con- 
tinuing several  days  if  necessary,  until  the  worm  is  passed. 

The  prophylaxis  includes  the  thorough  cooking  of  the  meat, 
especially  of  beef  and  pork,  from  which  tape-worms  are  usually 
gotten.  The  trichina  is  found  in  pork,  usually.  The  dejecta 
containing  ova  or  segments  of  the  worms  should  be  burned.  In 
all  cases  avoidance  of  impure  drinking  water  is  necessary. 

In  cases  of  trichiniasis,  if  infection  is  suspected  prompt  and 
thorough  treatment  should  be  made  as  described,  in  order  to 
get  rid  of  the  embryo  young  before  they  leave  the  intestine  and 
invade  the  muscles.  Later  a  course  of  treatment  for  the  general 
health,  and  general  muscular  treatment  should  be  given.  This 
will  reach  the  muscular  pains,  insomnia,  and  weakness. 


PRACTICE  OF  OSTEOPATHY. 


THE   INTOXICATIONS. 

Various  chronic  cases  of  alcoholism,  and  opium,  morphine, 
or  cigarette  habit  have  been  cured  under  osteopathic  treatment. 

CASES:  (1)  A  young  man  of  35  came  under  treatment  for 
"nervous  prostration"  due  to  chronic  alcoholism.  He  was  a 
nervous  wreck;  could  not  sleep  nor  digest  his  food;  had  palpita- 
tion of  the  heart;  the  lungs  and  kidneys  were  affected,  and  he 
suffered  from  frequent  attacks  of  sick  headache  and  constipa- 
tion. His  left  leg  was  varicosed.  He  suffered  much  from  melan- 
cholia, and  had  unbearable  craving  for  opium  or  whisky.  He 
had  taken  the  Keeley  cure  once,  another  cure  twice,  and  another 
five  times.  After  a  course  of  treatment  his  general  health  was 
very  much  improved,  and  he  had  no  desire  whatever  for  an  in- 
toxicant. 

(2)  Chronic  alcoholism  in  a  man  of  31.     The  patient  had 
taken  the  Keeley  cure  three  times,  and  had  taken  besides  several 
other  cures.     He  had  become  insane  from  the  use  of  a  drug,  the 
use  of  which  he  had  learned  while  under  treatment  of  one  of  these 
cures.     He  had  had  delirium  tremens  eight  times  in  three  years. 
During  all  this  time  he  had  never  lost  the  desire  for  whisky. 
He  was  a  nervous  wreck,  ate  but  little,  and  could  sleep  only  under 
the  influence  of  drugs.     At  the  time  of  beginning  treatment  he 
was  using  three  quarts  of  whiskey  a  day.     At  the  end  of  three 
weeks  treatment  he  was  using  no  stimulant,  and  his  appetite  for 
it  was  under  control.     At  the  end  of  the  second  month  he  was 
eating  and  sleeping  naturally,  and  all  desire  for  drink  was  gone. 
Four  months  later  he  was  still  well. 

(3)  A  woman  addicted  to  the  use  of  opium  came  under 
the  treatment.     Upon  leaving  off  the  drug  she  was    attacked 
with  great  pain,  which  was  relieved  by  the  treatment.     These 
pains  were  successfully  relieved  whenever  they  appeared,  and 
continually  grew  less  severe.     Gradually  the  system  was  built 
up  and  the  desire  for  the  drug  ceased. 

(4)  In  a  case  addicted  to  the  cigarette  habit  for  12  years,, 
all  desire  for  the  article  was  removed  by  the  treatment. 

(5)  A  man  of  about  33.  who  had  long  been  a  cigarette  smoker. 


396  PRACTICE  .OF    OSTEOPATHY. 

and  whose  nervous  system  had  been  wrecked  by  the  habit,  was 
cured  by  a  course  of  osteopathic  treatment. 

The  TREATMENT  in  these  conditions  is  practically  the  same. 
In  opium,  morphine,  and  cigarette  habit  the  effects  are  the  same, 
as  the  harm  is  done  by  the  opium. 

From  the  use  of  either  alcohol  or  opium  the  nervous  sys- 
tem becomes  undermined  and  comes  to  depend  upon  the  stim- 
ulant. Gradually  the  nervous  system  is  wrecked.  In  either 
•case  it  is  the  object  of  the  treatment  to  build  up  and  restore 
tone  to  the  nervous  system,  and  to  enable  it  to  do  without  the 
accustomed  stimulation  of  the  drug.  The  style  of  treatment  is 
&  thorough  general  spinal  and  cervical  one,  which  corrects  the 
circulation  to  the  brain  and  cord.  In  addition  treatment  is  de- 
voted to  buliding  up  the  general  health,  and  special  treatment 
is  given  to  the  various  symptoms  and  manifestations  as  neces- 
sary. In  this  way  the  system  is  strengthened  and  the  nature! 
functions  are  restored.  As  strength  is  gained  there  is  constantly 
less  desire  for  the  accustomed  drug.  The  desire  for  it  is  quite 
taken  away. 

In  case  of  opium  habit  the  principal  anatomical  changes  in 
the  tissues  are  due  simply  to  malnutrition,  consequently  a  gen- 
eral treatment  to  the  circulation,  nervous  system,  bowels,  stomach, 
liver,  etc.,  is  the  rational  method  of  repairing  the  effects  of  the 
drug.  The  muscular  cramps  are  treated  by  local  and  spinal 
inhibition;  the  insomnia  is  treated  as  before  described.  Pal- 
pitation, weakness,  dyspnea,  etc.,  are  readily  affected  by  keep- 
ing the  heart  stimulated,  the  ribs  raised,  etc. 

In  the  case  of  alcoholism  the  tissues  are  fat-infiltrated,  de- 
generated, cirrhotic.  congested  or  inflamed.  Liver,  kidneys, 
heart,  lungs  and  stomach  are  quite  likely  to  be  affected  by  these 
processes.  These  effects  in  the  various  organs  may  be  treated 
in  ways  described  in  considering  the  various  diseases  of  them. 
It  is  obvious  that  a  thorough  and  persistent  course  of  treatment 
is  necessary  to  correct  local  circulation  and  restore  these  tissues 
to  normal. 

Delirium  tremens  should  be  treated  as  described  for  con- 
vulsions. A  spinal  and  cervical  treatment  would  be  particularly 


PRACTICE    OF    OSTEOPATHY.  397 

indicated.     The  insomnia  yields  to  the  treatment  usually  made 
for  that  condition. 

SUNSTROKE    (Heat-Stroke;    Insolation;   Thermic    Fever)  and 
HEAT  EXHAUSTION. 

These  two  conditions  are  due  to  exposure  to  high  temper- 
ature. The  former  is  brought  on  by  exposure  to  the  direct  rays 
of  the  sun.  The  latter  is  contracted  by  persons  working  in  close, 
confined  places  in  high  temperature. 

The  state  of  the  patient  in  one  of  these  conditions  is  quite 
different  from  that  in  the  other. 

In  sunstroke  there  is  very  high  temperature,  106  to  115 
F.,  marked  dyspnea,  red  or  livid  skin  over  the  entire  body,  lack 
of  perspiration  generally,  a  full  pulse,  unconsciousness  and  coma. 

In  heat  exhaustion  there  is  cold,  clammy,  and  pallid  sur- 
face of  body;  the  temperature  is  normal  or  subnormal,  occasion- 
ally slightly  feverish;  the  pulse  is  full  and  small;  consciousness 
is  rarely  lost. 

The  TREATMENT  differs  some  in  these  two  conditions. 

Sunstroke  is  much  the  more  serious  condition.  It  must 
be  treated  promptly.  The  patient  should  be  laid  in  the  shade, 
the  clothing  should  be  loosened,  and  the  applications  of  cold 
water  to  head,  spine  and  surface  of  the  body  are  made.  Ice 
may  be  rubbed  over  the  surface  of  the  body,  or  the  patient  may 
be  put  in  an  ice-bath  (ice  in  the  water.)  Ice  water  enemata 
may  be  used.  After  the  temperature  has  been  reduced  the  pa- 
tient should  be  given  much  the  same  treatment  as  described  for 
apoplexy.  It  is  especially  important  to  relax  all  the  cervical 
muscles,  which  are  found  to  be  much  contracted.  The  spinal 
muscles  should  also  be  relaxed,  and  the  abdominal  treatment 
may  be  given  to  draw  the  blood  away  from  the  brain  and  cord. 
The  patient  should  be  kept  quiet,  and  the  heart  should  be  inhi- 
bited. Cervical  relaxation  and  inhibition  should  be  continu- 
ously applied. 

Heat  exhaustion  calls  for  less  treatment.  Usually  the 
patient  soon  recovers  if  removed  to  a  shady  spot,  with  the  clothing 
loosened,  and  sprayed  with  cool  water.  The  muscles  of  neck 
and  spine  should  be  first  relaxed,  and  the  whole  spinal  system, 


398  PRACTICE    OF   OSTEOPATHY. 

heart,  and  lungs,  should  be  thoroughly  stimulated.  In  case 
the  temperature  be  subnormal  the  patient  should  be  placed  in  a 
warm  bath. 

After-treatment  for  the  spine,  neck  and  general  system 
prevents  the  sequelae  that  are  so  frequently  the  results  of  sun 
or  heat-stroke,  such  as  headaches,  brain  affections,  intolerance 
of  heat,  etc. 

LIGHTNING  STROKE. 

Several  cases  have  been  treated  osteopathically  of  persons 
suffering  from  the  effects  of  lightning-stroke.  Paralytic  affects 
are  usually  found.  The  case  must  be  treated  upon  general 
principles,  usually  as  a  case  of  paralysis.  As  a  rule  marked  ver- 
tebral lesions  and  contractions  of  cervical  and  spinal  muscles 
are  found  resulting  from  the  stroke.  Good  results  are  gained  by 
treatment. 


DISLOCATIONS,     DEFORMITIES,     JOINT-AFFECTIONS,     ETC. 

This  class  of  troubles  furnishes  the  Osteopath  with  very 
numerous  cases.  The  marked  success  of  osteopathy  in  curing 
spinal  curvature;  setting  old  dislocations;  overcoming  chronic 
pain,  stiffness,  etc.,  in  joints;  overcoming  the  various  effects  of 
injuries  to  any  part  of  the  body;  curing  synovitis,  ankylosis, 
•etc.,  makes  this  line  of  practice  a  very  satisfactory  one. 

The  curing  of  spinal  curvature  without  the  use  of  braces 
or  mechanical  appliances;  the  removal'  of  plaster  casts,  jackets, 
splints,  bandages,  and  all  things  of  that  kind,  causing  the  natural 
resources  of  the  parts  to  be  depended  on,  is  a  novel  and  success- 
ful feature  of  Osteopathy. 

The  setting  of  old  dislocations  is  not  much  attempted  by 
other  lines  of  practice.  Great  success  is  met  in  this  line.  It 
is  evident  by  a  glance  at  the  case  reports  that  egregious  blunders 
are  repeatedly  made  by  the  most  skilled  physicians  in  many 
cases  of  this  and  similar  sorts.  "Tubercular  joints, "  "ruptured 
ligaments,"  "fractured  bones,"  and  various  other  serious  con- 
ditions are  often  found  by  the  Osteopath  to  be  partial  or  complete 
dislocations,  slips,  strains,  etc.,  which  are  curable. 


PRACTICE    OF    OSTEOPATHY.  399 

CASES:  A  few  typical  cases  of  deformity,  etc.,  in  each  of 
the  various  parts  of  the  body  subject  to  these  conditions  are  here 
presented.  Great  numbers  of  these  cases  are  upon  record,  but 
it  will  be  sufficient  to  confine  this  list  to  a  few  examples. 

(1)  A   pronounced    double    lateral    curvature,    in    a   young 
lady,   involving  the   whole  dorsal  region,  with  single  vertebral 
lesions  at  10th  and  llth  dorsal,  and  4th  and  5th  lumbar.     The 
spine  was  very  sensitive,  but  this  condition  was  overcome  by 
three  or  four  treatments.     After  twelve  treatments  the  patient, 
considerably    benefited,    went    away    upon    a    visit,    remaining 
several  months.     Upon  her  return  it  was  found  that  the  curva- 
ture   and    spinal    condition    were    materially   improved.     Seven 
more  treatments  cured  the  condition  entirely. 

(2)  Double  lateral   curvature   of   five  years   standing   in   a 
girl  of  twelve.     The  curvature  was  to  the  right  from  3rd  to  8th 
dorsal;  to  the  left  from  the  9th  dorsal  to  3rd  lumbar.     The  case 
was  cured  by  four  months  treatment. 

(3)  A  posterior  curvature  in  the  dorsal  region,  in  a  young 
boy,  general  health  was  poor.     After  two  weeks  treatment  the 
spinal  brace  was  removed,  and  after  two  months  treatment  the 
curvature  had  entirely  disappeared. 

(4)  Pott's  disease  of  eighteen  years  standing,  in  a  young 
lady  of  twenty-eight      It  came  on  gradually  after  a  fall  at  the 
age  of  eight,  having  developed  to  completeness  in  two  years. 
Casts  were  worn  for  two  and  a  half  years,  during  which  time 
two  abscesses  discharged,  one  just  below  the  anterior  superior 
spine  on  the  left,  the  other  hi  the  right  limb  just  below  the  groin. 
For  years  the  abscesses  would  alternately  heal  and  break.     The 
posterior  angular  projection  involved  the  vertebrae  from  the  4th 
dorsal  to  the  sacrum,  the  apex  being  at  the  10th  dorsal.     She 
came  under  treatment  at  the  age  of  twenty-eight.     Both  ab- 
scesses were  discharging  freely;  after  three  months  treatment 
a  third  abscess  appeared,  and  the  patient  appeared  to  grow  worse. 
After  this  she  began  to  improve  and  the  curvature  began  to  yield. 
Two   abscesses  healed.     Gradually   the   curvature   was  reduced 
until  scarcely  noticeable,  and  the  3rd  abscess  was  nearly  healed. 
The  general  health  was  perfect.     The  patient's  height  had  been 
increased  two  and  a  half  inches. 


400  PRACTICE   OF   OSTEOPATHY. 

(5)  A  thyroid  dislocation  of  the  hip  set  in  one  treatment. 

(6)  A  dislocation  of  the     hip  of  three  years  standing;  the 
patient  had  been  upon  crutches  ever  since  the  accident  pro- 
ducing the  injury.     The  hip  was  set  in  three  treatments,  and 
the  patient  had  no  use  for  crutches  thereafter. 

(7)  A  dislocation  of  the  hip  of  four  years  standing  in  a  case 
which  had  been  thrown  from  a  buggy.     The  femur  had  been 
fractured  at  the  same  time.     The  hip  was  set  in  three  months 
treatment. 

(8)  Tuberculosis  of  the  hip  and  spine,  so-called,  in  a  girl 
of  sixteen,  of  four  years  standing.     The  best  physicians  had  pro- 
nounced it  tuberculosis  of  the  hip.     The  hip  was  found  to  be 
slightly  dislocated  downward  and  forward,  and  there  was  ver- 
tebral lesion  of  the  3rd  and  4th  lumbar.     The  hip  was  set  and 
the  case  entirely  cured  hi  four  months. 

(9)  A  case  diagnosed  by  the  physician  as  hip-joint  disease. 
The  patient  had  been  confined  to  his  cot  for  ten  months.     A 
partial  dislocation  of  the  hip  was  found  and  set  in  three  months 
treatment,  curing  the  case. 

(10)  Partial  dislocation   of  hip   and   knee-joints.     The   pa- 
tient had  worn  a  laced  leather  stocking  from  the  ankle  half-way 
to  the  thigh  for  eleven  months.     He  walked  with  a  crutch.     The 
case  had  been  diagnosed  as  "rupture  of  the  internal  lateral  lig- 
ament of  the  knee"  by  two  prominent  Chicago  physicians.     The 
dislocations  were  set  in  nine  treatments. 

(11)  A  case  which  had  been  diagnosed  as  a  "complicated 
fracture  of  the  neck  of  the  femur,"  of  five  years  standing.     Spec- 
ialists had  confirmed  this  diagnosis.     The  injured  limb  was  three 
inches  shorter  than   the   other.     Osteopathically  the   case   was 
diagnosed  as  a  dislocation  and  was  cured. 

(12)  Tuberculosis   of   the   knee,   so-called,   in   a   boy.     The 
joint  was  put  in  a  cast.     There  was  constant  pain  in  it.     A  slip 
of  the  hip-joint  was  found,  and  its  adjustment  cured  the  case. 

(13)  Torticollis   due   to   contraction   of   the   sterno-mastoid 
muscles.     By  four  treatments  the  muscle  was  relaxed,  and  the 
condition  was  cured. 

(14)  Torticollis  of  many  years   standing,    caused  by  injury 
to  the  neck.     The  muscles  were  extremely  rigid,  and  the  cervical 


PRACTICE    OF    OSTEOPATHY.  401 

vertebrse  were  badly  curved  and  twisted.  There  was  constant 
pain  in  head,  neck,  and  eyes.  The  case  was  greatly  relieved 
permanently  by  the  treatment. 

(15)  Injury  of  the  knee  and  shoulder- joints  in  a  bicycle 
accident.     The  knee  condition  had  been  diagnosed  as  rupture 
of  the  ligaments.     By  three  weeks  treatments  the  shoulder  and 
knee  were  entirely  cured. 

(16)  Tubercular  knee  in  a  boy  six  years  old.     The  knee 
was  swollen,  and  the  temperature  was  103  F.     The  case  was 
much  benefited  by  three  weeks  treatment,  and  was  well  on  the 
way  to  recovery.     The  10th  and  llth  dorsal,  1st,  2nd,  3rd,  and 
4th  lumbar  vertebrse  were  posterior. 

(17)  A  long  standing  pain  in  the  shoulder,  which  had  been 
examined  and  treated  by  eminent  physicians  both  in  Europe 
and  America  without  relief.     Lesion  was  found  in  crowding  to- 
gether of  the  2nd  and  3rd  dorsal  vertebrae.     After  one  treatment 
the  patient  suffered  no  further  pain. 

(18)  Partial  dislocation   of  the    head    of  the    humerus,   of 
some  months  standing,  causing  a  painful  condition  which  had 
been  treated  as  rheumatism.     The  case  was  cured  by  setting 
the  bone. 

(19)  Fibrous  ankylosis  of  the  elbow-joint  in  a  boy  of  five, 
due  to  being  kept  in  splints  too  long  after  fracture  of  the  humerus. 
The  condition  was  of  eight  weeks  standing.     By  the  treatment 
use  of  joint  was  gradually  perfectly  restored. 

(20)  Broken  down  arches  of  the  feet  in  a  man  of  twenty- 
eight,  due  to  rheumatism  which  had  settled  in  the  ankles.     The 
astragalus  was  markedly  dislocated  to  the  inner  side.     For  two 
years  the  patient  had  worn  braces  to  support  the  arch  of  the 
instep.     By   the   treatment   the   bones   were   replaced   and   the 
arches  were  rebuilt  into  their  natural  condition.     The  case  was 
cured  in  six  weeks. 

TREATMENT   OF    DISLOCATIONS,    DEFORMITIES,    AND 
JOINT-AFFECTIONS. 

While  the  treatment  of  each  of  these  conditions  will  be  dis- 
cussed separately,  some  general  remarks  apply  to  them  collec- 
tively. The  marked  success  of  Osteopathy  in  cases  of  this  kind 


402  PRACTICE    OF   OSTEOPATHY. 

is  largely  due,  at  bottom  to  an  intimate  knowledge  of  nerve 
and  blood-supply  of  the  affected  part,  patience  and  skill  in  manip- 
ulation, and  the  ability  to  relax,  strengthen,  or  build  up  tissues, 
open  a  joint  and  direct  the  circulation  to  it,  and  in  all  respects 
to  thoroughly  prepare  parts  concerned  to  be  returned  to  the 
normal  state.  In  the  recent  case  this  preparatory  treatment 
does  not  take  long.  In  the  chronic  one,  which  represents  a  con- 
siderable majority  of  this  class,  this  preparation  may  necessarily 
extend  over  many  months.  It  is  here  that  patience  and  skill 
play  an  important  part.  Often  the  preliminary  work  done  in 
getting  all  parts  ready  to  be  restored  to  normal  is  the  most  im- 
portant and  most  distinctively  osteopathic  part  of  the  process. 
When  parts  are  once  prepared,  as  for  example  in  the  setting  of  a 
hip,  the  final  manceuver  used  to  replace  the  bone  in  position  is 
practically  the  same  as  a  surgeon  would  use  for  the  purpose. 

These  remarks  apply  with  almost  equal  force  to  both  disloca- 
tions and  deformities.  Yet  in  the  latter  case  the  correction  of 
position  of  bony  parts  is  continually  going  on,  pari  passu  with 
the  process  of  the  treatment.  In  case  of  joint-affections  this 
process  of  treatment  constitutes  the  whole  course  of  procedure, 
yet  it  not  infrequently  occurs  that  the  replacing  of  a  slipped 
bony  part  is  a  portion  or  the  whole  of  the  treatment  of  a  joint- 
affection. 

TREATMENT  OF  SPINAL  CURVATURES  AND  OF  POTT'S  DIS- 
EASE: The  treatment  of  the  various  forms  of  spinal  curvature 
and  of  Pott's  disease  are  upon  much  the  same  lines.  In  all, 
the  preliminary  work  as  described  is  of  the  utmost  importance. 
It  constitutes  much  of  the  course  of  treatment,  but  bony  parts 
are  drawn  and  pressed  back  into  place  all  the  while. 

Spinal  curvatures  are  rarely  painful,  but  when  they  are  the 
first  step  in  the  treatment  is  to  carefully  relax  all  spinal  tissues, 
deep  and  superficial;  to  increase  or  correct  circulation  in  tluMn; 
and  in  these  ways  to  gradually  work  out  the  soreness  and  to 
strengthen  them. 

In  any  case  of  curvature  this  sort  of  treatment  constitutes 
the  first  step  in  the  procedure.  To  this  end  one  may  use  any  or 
all  of  the  treatments  described  under  I,  II,  III,  IV,  and  V,  in 
Chap.  II.  In  this  way  the  spine  is  gradually  strengthened  through- 


PRACTICE    OP    OSTEOPATHY.  403 

out ;  the  muscles  and  ligaments  are  given  greater  strength  to  hold 
the  ground  gradually  gained,  now  and  later,  in  the  form  of  the 
slow  restoration  of  bony  parts  toward  the  normal  position. 

Likewise,  during  this  process  of  treatment,  the  interverte- 
bral  discs,  which  have  been  altered  in  shape  by  pressure  atrophy, 
are  gradually  freed  of  unequal  pressure  and  are  rebuilt  into  proper 
shape  by  properly  distributed  pressure  and  by  the  renewed  blood- 
circulation. 

After  a  short  preliminary  treatment,  or  at  once  if  the  case 
allows,  attention  is  directed  to  the  replacement  of  bony  parts. 
It  is  a  good  rule  in  spinal  curvatures  to  begin  at  the  lowest  ver- 
tebra involved  and  make  an  attempt  at  each  treatment  to  set 
it  back  into  place.  When  this  has  been  accomplished,  and  while 
it  is  going  on.  the  next  vertebra,  then  the  next,  and  the  next, 
and  so  on,  is  attempted.  Much  may  be  gained  in  this  way. 

Suspension  of  the  patient  in  the  osteopathic  swing,  or  in 
the  special  apparatus  devised  for  the  suspension  of  curvature 
patients,  is  a  great  help  to  the  practitioner  in  the  treatment. 
By  this  device  the  weight  of  the  patient's  body  is  used  to  help 
draw  the  bony  parts  back  into  place  during  the  various  special 
treatments  employed  for  that  purpose.  In  this  way  very  rapid 
gain^  have  been  made  in  straightening  the  curve. 

Various  special  movements  may  be  successfully  applied 
to  the  reduction  of  the  bony  parts.  The  treatments  described 
under  VI.  VII.  VIII.  IX.  X. 'x(a).  XI.  XII.  XVII.  and  XVIII, 
in  Chap.  II.  may  be  used  and  combined  as  desired.  This  style 
of  treatment  should  be  combined  all  the  time  with  that  described 
as  the  first  step  in  the  process  of  treatment.  The  treatment 
must  be  most  persistently  and  assiduously  applied,  the  practi- 
tioner using  a  considerable  degree  of  force  to  put  parts  back  into 
place.  But  violence  must  be  avoided. 

During  the  course  of  the  treatment  all  spinal  braces,  jackets, 
casts,  and  artificial  supports  or  corrective  mechanisms  of  even- 
sort  are  laid  aside,  either  gradually  or  at  once  as  the  patient  may 
be  able  to  do  without  them.  In  this  way  one  gets  rid  of  their 
irritating  local  effects  and  of  their  detrimental  influence  upon 
the  general  health,  while  at  the  same  time  the  parts  are  taught 
to  depend  upon  their  own  strength,  a  matter  essential  to  a  cure. 


404  PRACTICE   OF   OSTEOPATHY. 

Due  attention  must  be  given  to  complications  and  to  the 
general  health. 

The  practitioner  must  bear  in  mind  the  changed  relations 
assumed  by  the  ribs  both  with  respect  to  each  other  and  with 
respect  to  the  vertebrae.  Treatment  must  be^  applied  during 
the^.  course  of  treatment,  to  the  adjusting  of  these  ribs.  The 
various  special  methods  described  in  Chap.  VII  may  be  used. 

This  method  of  treatment  applies  to  SCOLIOSIS,  LORDOSIS. 
KYPHOSIS,  and  their  combinations. 

In  case  of  POTT'S  DISEASE  the  same  general  plan  of  treat- 
ment is  followed.  In  case  the  destructive  process  in  the  bones 
and  discs  has  ceased,  and  cure  by  deformity  has  followed  by  bony 
ankylosis  of  the  vertebrae,  one  cannot  straighten  the  spine,  but 
much  may  be  done  to  correct  the  general  health.  Yet,  as  in 
the  case  reported  above  (see  case  reports),  it  often  happens  that 
after  years  of  deformity  the  spine  has  been  materially  straightened. 

In  this  disease  the 'destructive  processes  can  be  quite  stopped 
often,  or  greatly  limited;  general  health  is  bettered,  and  pain  is 
relieved. 

In  these  cases  thorough  attention  to  the  general  health  is 
necessary.  Also  bowels,  kidneys,  liver,  and  skin  must  be  kept 
well  stimulated  to  aid  in  carrying  off  the  septic  products  of  the 
disease.  In  case  of  the  appearance  of  abscess,  it  must  be  drained 
when  it  has  come  to  a  head.  Such  quantities  of  pus  cannot  be 
absorbed,  and  the  abscess  should  not  be  allowed  to  break.  After 
drainage  the  abscess  may  be  entirely  healed  by  the  treatment. 

Various  swerves  in  the  spine,  or  departures  from  the  nor- 
mal curves,  are  frequently  met  with.  They  are  often  called 
curvatures,  but  are  not  properly  so  regarded.  Yet  they  may 
predispose  to  curvatures.  They  may  be  readily  righted  by  the 
treatments  given  above. 

Pott's  disease  requires  a  long  and  patient  course  of  treat- 
ment. This  is  often  true  of  the  ordinary  curvatures,  but  very 
frequently  a  single  month,  or  a  few  months,  of  treatment  will 
show  surprising  results. 

The  TREATMENT  OF  DEFORMITIES  proceeds  upon  much  the 
same  general  plan  of  treatment  as  described  for  curvatures. 
All  the  surrounding  parts  must  be  relaxed,  strengthened  and 


PRACTICE    OF    OSTEOPATHY.  40t5 

prepared  by  a  course  of  treatment  directed  to  the  complete  restor- 
ation of  circulation  to  the  parts  and  tissues  involved.  When 
the  preparation  is  completed  the  practitioner  proceeds  by  ex- 
aggeration of  lesions,  traction,  pressure,  rotation,  etc..  applied 
to  the  bony  part  to  force  it  back  into  place. 

It  often  happens  that  in  apparent  deformity  of  a  bony  part, 
as  of  a  joint,  while  pain  and  abnormal  position  and  condition  of 
the  tissues  is  apparent  at  the  joint,  the  real  cause  may  be  an  ob- 
struction in  the  nerve  and  blood-supply  of  the  joint  somewhere 
above  or  at  the  spine.  Thus  apparent  deformity  of  a  knee  has 
with  much  frequently  been  found  to  be  due  to  a  luxation  of  the 
hip-joint  or  of  spinal  vertebra-. 

A  deformity,  as  an  enlargement  of  a  joint,  may  be  not  real 
but  apparent  by  reason  of  atrophy  of  the  surrounding  tissues. 
Then  the  cause  must  be  sought  elsewhere  for  the  wasting  of  the 
tissues.  But  the  surrounding  tissues  often  waste  in  cases  of 
joint  disease  or  deformity. 

It  sometimes  happens,  as  in  the  case  of  "hysterical  joints" 
that  there  is  no  real  diseased  condition  of  the  kind  suspected. 

.Muscular  and  ligamentous  deformities  are  often  the  results 
of  some  preceding  or  existing  disease.  In  such  cases  treatment 
must  be  made  accordingly.  Locally  one  must  direct  treatment 
to  the  affected  tissues  te  relax  and  restore  them. 

On  the  other  hand  these  muscular  and  soft  tissue  deform- 
ities are  surprisingly  often  found  to  be  due  to  a  vertebral  lesion, 
or  other  lesion,  at  the  origin  or  in  the  course  of  the  nerves  supply- 
ing the  part.  In  such  case  the  treatment  must  embrace  the  re- 
moval of  lesion  as  the  real  cause,  and  corrective  work  upon  the 
deformed  tissues.  It  sometimes  happens  in  the  treatment  of 
these  cases  that  the  spinal  lesion  is  treated  to  the  exclusion  of 
the  local  treatment  upon  the  affected  part,  or  that  treatment  is 
mistakenly  directed  to  a  spinal  lesion  not  responsible  for  the  con- 
dition. One  will  learn  that  he  must  judge  of  the  relative  import- 
ance of  treatment  directed  to  one  situation  or  the  other. 

Sometimes  a  minute  luxation  of  a  joint  itself  is  the  cause 
of  the  trouble. 

In  cases  of  deformity  due  to  deposits  in  and  about  joints,  as 
in  chronic  rheumatism,  the  circulation  is  built  up  and  kept  stim- 


406  PRACTICE    OF    OSTEOPATHY. 

ulated  to  absorb  the  deposit.  In  such  cases  it  is  necessary  to 
adapt  some  motion  to  thoroughly  stretching  or  spreading  the 
joint  in  order  that  the  renewed  blood-supply  may  freely  circu- 
late in  the  joint. 

Various  special  treatments  applicable  to  the  treatment  of 
deformities  will  be  found  described  in  the  general  treatments 
for  the  upper  and  lower  limbs. 

The  TREATMENT  OF  DISLOCATIONS  is  fully  described  in 
Chap.  X. 

Concerning  the  TREATMENT  OF  JOINT  AFFECTIONS  little 
need  be  added  to  what  has  been  said  in  describing  the  treatment 
of  deformities  (see  also  the  treatment  of  rheumatism.)  Pain  in 
a  joint  is  often  to  be  due  to  a  spinal  lesion  or  to  a  lesion  in  a  re- 
lated joint.  A  very  common  occurrence  is  to  discover  the  cause 
of  a  so-called  tubercular  knee,  or  of  a  swelling  or  synovitis  of  the 
knee-joint,  in  a  luxation  of  the  hip-joint. 

In  all  cases  of  joint  affections  one  must  look  closely  for 
lesion  to  nerves  or  vessels  supplying  the  joint  from  the  origin 
down,  and  remove  it  as  the  cause  of  the  trouble.  To  this  must 
be  added  local  manipulation  of  the  joint  and  its  parts  in  order 
to  correct  proper  circulation. 

Plaster  casts  and  bandages  are  at  once  removed  to  aid  in 
securing  freedom  of  blood  circulation. 

One  must  not  forget  that  apparently  very  serious  disease 
has  often  been  found  by  osteopaths  to  depend  upon  a  slight  slip 
of  the  bones  or  cartilages  of  the  joint  affected.  Treatment  upon 
the  principles  laid  down  will  usually  suffice  to  slip  these  back  into 
place. 

In  strains,  sprains,  and  inflammations  of  a  joint  one  must 
free  the  local  and  the  connected  circulation  to  take  down  the 
inflammation.  If  applications  are  used,  hot  are  better  than  cold. 

In  chronic  affections  it  is  usually  necessary  to  treat  from 
the  spine  out  to  the  joint  in  question,  besides  removing  all  bony 
lesions,  adjusting  all  tissues,  etc. 

Moderate  use  of  a  joint  is  usually  advised,  at  discretion. 
The  use  builds  up  a  natural  condition. 

Cases  of  bony  ankylosis  are  incurable  without  breaking. 
Llgamentous  ankylosis  may  be  cured.  If  any  motion  at  all  ex- 


PRACTICE  OF  OSTEOPATHY.  407 

ists  in  a  joint  there  is  good  reason  for  belief  that  it  may  be  in- 
rrr;isod,  possibly  fully  restored. 


DISEASES  OF  WOMEN. 

CASES:  (1)  Dysmenorrhcea  and  irregularity  of  menstrua- 
tion, with  a  complication  of  troubles  in  a  young  lady  of  t  \vcnty- 
five.  The  lower  dorsal  and  lumbar  vertebrae  were  anterior. 
The  case  was  cured  in  ten  weeks,  having  gained  22  pounds. 

(2)  Dysmenorrhoea  in  a  married  woman  of  38.     At  each 
period  she  was  confined  to  her  bed,  there  being  menorrhagia, 
headache,  nausea,  etc.     The  condition  was  of  12  years  standing, 
since    childbirth.     The    uterus    was    prolapsed  and  retroverted. 
The   right   innominate  was  posterior.     The  bone  was  replaced, 
the  uterus  put  into  correct  position,  and  the  case  wras  discharged 
cured  in  two  months. 

(3)  Dysmenorrhoea   of   3  years  standing   in   a  young  lady 
of  21.     Lesions  were:  5th  lumbar  to  the  right,  and  surrounding 
tissues   much   contracted;  9th,   10th  and   llth  dorsal  vertebrae 
luxated  and  that  portion  of  the  spine  rigid.     Patient's  general 
health  was  much  affected.     The  case  was  cured  by  removal  of 
lesion  in  two  months. 

(4)  Amenorrhcea.    with    a    complication    of    troubles,    in    a 
woman  of  22,  of  13  months  standing.     The  greatest  gynecolo- 
gist in  Cincinnati  said  the  uterus  was  atrophied  and  she  would 
never    menstruate    again.     Lesions    were:  7th    dorsal    spine    to 
right  and  whole  spine  rather  irregular;  pelvis  twisted  with  ap- 
parent lengthening  of  right  limb.     The  case  was  benefited  from 
the  beginning  of  treatment  and  was  cured  in  four  months.    Menses 
appeared  in  six  weeks. 

(5)  Amenorrho?a  of  7  months  standing  in  a  case  in  which 
the  period  had  been  very  irregular,  often  not  occurring  for  three 
or  four  months.     The  general  health  was  much  affected.     After 
two  weeks  treatment  she  was  much  better,  and  the  menses  ap- 
peared.    Under  the   treatment  the  patient  gainted   rapidly  in 
weight,  the  normal,  period  being  re-established. 

(6)  Amenorrhcea   in   a   young   woman,    of   over   8   months 
standing.     Lesions  were:  2nd  lumbar  posterior;  1st,  2nd  and  3rd 


408  PRACTICE    OF    OSTEOPATHY. 

dorsal  lateral;  5th  lumbar  anterior.  Treatment  corrected  the 
lesions  and  cured  the  case  in  three  months,  the  patient  having 
gained  12  pounds. 

(7)  Amenorrhcea  of  more  than  a  years  standing  in  a  young 
woman.     Lesions:  4th  and  5th  lumbar  anterior;  luxation  of  8th 
and  9th  dorsal,  and  stricture  of  the  os.     Lesions  were  corrected 
and  the  os  was  relaxed  by  spinal  work.     Menstruation  came  on 
normally. 

(8)  Menorrhagia  and  dysmenorrhoea.     The  menstrual  flow 
started  upon  the  least  exercise.     The  curves  of  the  spine  were 
straightened,   and   there   were   many  slight  irregularities  in   it. 
The  coccyx  was  lateral  to  the  right  and  anterior.     The  case  was 
first  treated  during  period,  and  the  flow  ceased  at  once,  not  re- 
turning for  four  months,  after  which  it  was  normal. 

(9)  Uterine  hemorrhage  suddenly  appearing  with  abdominal 
pains.     The  latter  were  intense   and   the  hemorrhage  profuse. 
One  treatment  entirely  relieved  the  trouble. 

(10)  Uterine  hemorrhage,  frequent  and  profuse,  in  a  married 
woman  who  had  previously  undergone  operation  for  the  removal 
of  uterine  fibroid-  tumors.     The  uterus  was  retroverted,  the  left 
innominate  anterior,  and  the  2nd  and  3rd  lumbar  vertebrae  lux- 
ated.    The  hemorrhages  ceased  after  the  second  treatment. 

(11)  Metrorrhagia  of  2  years  standing.     The  right  innom- 
inate was  slipped  upward,  and  its  correction  entirely    cured  the 
trouble. 

(12)  Prolapsus  of  the  uterus  in  a  lady  of  40,  who  had  suffered 
with  spinal  trouble  and  dysmenorrhrea  for  26  years.     The  pa- 
tient had  been  taking  local  treatment  for  uterine  displacement 
and  other  trouble  twice  a  week  for  two  years.     After  three  months 
of  osteopathic  treatment,  in  which  time  about  five  local  treat- 
ments were  given,  the  prolapsus,  leucofrhcea,  etc.,  were  cured. 
Practically  all  the  treatment  was  upon  spinal  lesion,  the  spine 
having  been  found  swerved  one  and  one-half  inches  laterally. 
It  was  corrected. 

(13)  Prolapsus  of  the  uterus,  with  retroversion,  hi  a  woman 
of  forty  of  sveral  years  standing.     Lesion  was  a  slight  displace- 
ment of  an  innominate.     The  case  was  cured  by  local  and  spinal 
treatment.     The  lesion  was  corrected. 


PRACTICE    OF    OSTEOPATHY.  409 

(14)  Leucorrhcea   in   a   married   woman   of   thirty.     Lesion: 
slight  deviation  of  lower  dorsal  and  lumbar  vertebrae  to  the  left. 
Upon  correction  of  spinal  lesion,  in  less  than  one  month,  the  case 
was  cured. 

(15)  Leucorrhcea,    congestion   of   the   ovaries,    and   painful 
menstruation,    of    three    years    standing.     The    left    innominate 
bone  was  luxated,  and  lesion  also  occurred  at  the  10th  and  llth 
dorsal  vertebrae.     The  case  was  cured  in  four  months. 

(16)  Vaginal    cyst    in  a    woman    of   forty,    following  subin- 
volution  and  prolapsus  of  the  uterus  after  child-birth  three  years 
previously.     The  cyst  was  about  the  size  of  a  hickory  nut,  and 
had  formed  about  four  months  previously  to  the  time  of  exami- 
nation.    Spinal  lesion  present  was  a  separation  between  the  nth 
lumbar  and  sacrum.     Treatment  consisted  mainly  in  correction 
of  spinal  lesion.     Local  treatment  was  given  to  restore  tonicity 
to  the  very  lax  vaginal  walls,  and  to  improve  venous  and  lymphatic 
•drainage.     The  cyst  entirely  disappeared  by  six  weeks  treatment. 

(17)  Vaginal  irritation  due  to  lesion  as  a  tilted  ilium,  which 
•\vas  removed  and  the  case  was  cured. 

(18)  Chronic    hemorrhagic    endometritis    in    a    woman    of 
fifty-seven,  who  had  not  walked  for  three  years,  and  who,  for 
eighteen  months  had  been  unable  to  sit  up,  as  the  slightest  ex- 
ertion caused  hemorrhage.     The  condition  was  of  thirty  years 
standing.     Lesions:  3rd    and    4th    cervical    vertebrae    anterior, 
from  ninth  dorsal  to  sacrum  decidedly  posterior.     Improvement 
Mas  marked  after  one  months* treatment,  patient  being  able  to 
walk  about  the  house.     The  case  was  cured  in  three  months. 
The  patient  was  still  well  two  years  later. 

(19)  Salpingitis  in  a  married  woman,  multipara,  who  had 
previously    suffered    acute    suppression    of    menses.     The    condi- 
tion became  very  acute,  and  operation  was  advised.     The  pa- 
tient was  in  great  agony.     At  this  point  an  Osteopath  was  called. 
Light  spinal  and  local  abdominal  treatment  relieved  the  pain  in 
half  an  hour,  and  the  patient  slept  for  six  hours,  the  first  natural 
sleep  in  a  number  of  days.     She  was  awakened  by  fresh  pain, 
caused  by  the  natural  discharge  of  about  1  pint  of  pus.     Two 
or  three  light  treatments  were  given  before  evening  of  the  next 
day,  and  the  soreness  entirely  disappeared.     The  patient  was 


410  PRACTICE    OF    OSTEOPATHY. 

able  to  be  about  that  day.     No  return  of  trouble  occurred. 

(20)  Inflammation  of  the  ovaries  in  a  woman  of  twenty- 
six,  of  several  years  standing.     For  four  years  ordinary  treat- 
ment had  been  tried.     Operation  was  advised.     Lesions:  mus- 
cular contractures  in  the  middle  dorsal  and  lower  lumbar  regions, 
the  whole  spine  being  weak.     The  case  was  cured  in  two  months. 

(21)  Acute  inflammation  of  the  ovary  in  a  woman  of  thirty- 
five.     Lesions:  5th  lumbar  posterior,  sacral  muscles  contracted 
and  sensitive,  muscular  contractions  in  the  region  of  the  affected 
ovary.     The  case  was  treated  twice  daily  for  three  days  and  was 
cured. 

(22)  Ovarian  colic  in  a  case  in  which  there  had  been  acute 
attacks  previously.     A   cold   had   contractured   the   muscles  on 
the  left  side  of  the  lower  lumbar  spine.     The  right  innominate 
was  displaced  doward  and  forward.     The  patient  was  in  great 
pain.     Relief  was  immediate,  and  the  case  was  cured  in  one  treat- 
ment. 

(23)  Climacteric,  with  dropsy  and  asthma,  in  a  patient  of 
fifty-two.     For  one  year  the  patient  had  suffered  with  all  the 
trying  symptoms  of  the  menopause.     Lesions  were  found  at  the 
spinal  connections  of  the  cardiac,  hepatic,  renal,  ovarian,  uterine, 
and  hypogastric  plexuses.     Improvement  was  immediate.     No 
asthma  appeared  after  the  second  treatment,  the  patient  grew 
strong  and  was  entirely  cured  in  three  months. 

(24)  Phlegmasia   Alba    Dolens    (Milk-leg)    in    a   woman    of 
twenty-three,  of  three  weeks  standing.     There  was  innominate 
lesion,  marked  tenderness  in  the  sacro-iliac  region,  and  lesions 
at  the  6th  and  7th  dorsal.     The  treatment  was  largely  confined 
to  the  lesions,  and  the  milk-leg  symptoms  disappeared  in  three 
treatments.     The  case  was  cured. 

When  the  case  was  taken  under  treatment  the  fever  was 
103,  the  leg  was  much  swollen  and  very  painful,  confinement 
had  occurred  three  weeks  before. 

LESIONS  AND  ANATOMICAL  RELATIONS. 

The  lesions  in  cases  of  women's  diseases  are  practically  all 
found  below  the  eighth  dorsal.  Considering  the  multiplicity  of 
diseases  it  is  interesting  to  note  that  they  are  almost  without. 


PRACTICE  OF  OSTEOPATHY.  411 

exception  traced  to  actual  spinal  lesion  at  the  centers  controll- 
ing the  pelvic  viscera,  or  upon  the  closely  related  nerves.  Le- 
sion is  as  near  specific  in  this  class  of  cases  as  in  any. 

(Jenerally  speaking,  lesion  may  be  expected  anywhere  among 
the  lower  three  or  four  dorsal  vertebra?  and  corresponding  ribs, 
among  the  lumbar  vertebra^,  at  the  lumbo-sacral  articulation,  at 
the  innominates,  sacrum  and  coccyx.  It  is  very  common  to 
find  lesion  at  the  9th,  10th,  or  llth  dorsal,  affecting  the  center 
of  blood-supply  to  the  ovaries;  at  the  2nd  lumbar,  affecting  the 
blood-supply  to  the  uterus;  and  at  the  4th  and  oth  lumbar,  at 
which  point  lesion  is  particularly  apt  to  occur  affecting  the  hypo- 
gastric  plexus,  and  through  it  the  pelvic  viscera.  Cases  have 
been  observed  in  which  a  displaced  lower  rib  irritated  an  ovary 
and  caused  disease  in  it.  The  oth  lumbar  lesion  is  perhaps  the 
most  frequent  one,  it  Ix  ing  at  the  same  time  a  weak  point  ana- 
tomically, therefore  particularly  liable  to  lesion,  and  in  important 
relation  to  the  hypogastric  plexus. 

Innominate  lesion  is  perhaps  the  next  most  frequent.  Its 
relation  to  the  sacral  nerves,  which  are  so  closely  connected  with 
the  pelvic  viscera,  accounts  for  its  importance. 

Such  lesions  as  have  been  pointed  out  as  the  causes  of  enter- 
optosis  and  prolapse  of  the  diaphragm  become  important  causes 
of  prolapsus  of  pelvic  viscera  by  pressure  from  above,  and  by 
weakening  the  supports  of  these  organs,  also  of  congestive  dis- 
turbances such  as  must  follow  in  such  a  state  of  affairs. 

In  female  diseases  one  should  look  for  lesion  especially  at 
the  5th  lumbar,  at  the  innominates,  at  the  2nd  lumbar,  and 
about  the  9th,  10th.  and  llth  dorsal.  There  is  sometimes  irri- 
tation of  the  internal  pudic  nerve  where  it  emerges  from  the 
pelvis  to  cross  the  spine  of  the  ischium.  The  ovarian  vessels  are 
frequently  obstructed  by  enteroptosis,  especially  by  ptosis  of 
the  transverse  colon. 

In  menstrual  disorders  lesions  occur  from  the  10th  dorsal 
to  the  4th  or  oth  sacral,  and  among  the  lower  ribs.  Painful 
menstruation  is  often  found  to  be  due  to  lesion  at  the  5th  lumbar 
and  at  the  innominates. 

The  lesions  as  described  are  seen  to  be  at  points  where  they 
interfere  with  the  nerve-connections  and  circulation  of  the  pelvic 


412  PRACTICE    OF    OSTEOPATHY. 

viscera.  There  are  two  groups  of  vaso-motor  nerves  for  the 
genitalia,  one  in  the  lumbar  region  and  the  other  in  the  sacral, 
as  pointed  out  in  the  American  Text-Book  of  Physiology.  For 
the  external  genital  organs  vaso-motor  fibres  rise  from  the  2nd, 
3rd,  4th,  and  5th  lumbar  nerves,  run  forward  in  the  white  rami 
communicantes,  and  pass  through  the  pelvic  plexus  and  pudic 
nerve  to  reach  the  organs  they  supply.  From  the  anterior  roots 
of  the  sacral  nerves  rise  vaso-motors  which,  when  stimulated. 
dilate  the  vessels  of  the  external  genitals.  Vaso-constrictors  for 
the  fallopian  tubes,  uterus,  and  vagina  in  the  female,  and  for  the 
vasa  deferentia  and  vesiculae  seminales  in  the  male,  are  found  in 
the  sacral  nerves.  The  2nd,  3rd,  4th,  and  oth  lumbar  nerves  send 
vaso-motor  fibres  to  the  internal,  as  well  as  to  the  external  gen- 
itals. 

According  to  Quain's  anatomy,  it  is  probable  that  sensory 
nerves  pass  through  the  sympathetic,  those  supplying  the  ovary 
from  the  10th  dorsal;  those  supply  the  uterus  (a)  in  contraction, 
from  the  llth  and  12th  dorsal  and  1st  lumbar,  (b)  os  uteri,  (1st), 
2nd,  3rd,  4th  sacral ,  (5th  lumbar  rarely.)  It  is  seen  that  these 
points  have  been  found  as  the  seat  of  lesion  in  pelvic  disorders. 
This  sensory  innervation  is  made  practical  use  of  in  pelvic  dis- 
orders. Often  by  preliminary  inhibition  along  this  spinal  re- 
gion pain  is  quieted. 

Quain's' anatomy  also  notes  motor  fibres  for  the  uterus 
passing  into  the  sympathetic  from  the  lower  dorsal  and  upper 
one  or  two  lumbar  nerves,  and  reaching  the.  uterus  via  the  aortic 
plexus,  the  inferior  mesenteric  ganglion,  hypogastric  and  pelvic 
plexuses.  Also  motor  fibres  to  the  uterus  descending  from  the 
lumbar  region  and  terminating  in  the  sacral  ganglia.  It  is  at 
once  seen  that  lower  dorsal  and  upper  lumbar  lesion  is  important, 
as  it  affects  this  distribution  via  the  inferior  mesenteric  ganglion. 
The  other  lumbar  lesions  are  also  seen  to  be  important. 

According  to  Foster's  physiology,  stimulation  of  the  in- 
ferior mesenteric  ganglion  causes  circular  contractions  of  the 
uterus,  with  descent  of  the  cervix  and  dilatation  of  the  os.  Stim- 
ulation of  the  sacral  nerves  contracts  the  longitudinal  fibres, 
shortens  the  cervix,  and  closes  the  os. 

These  various  motor  effects  are  used  by  the  Osteopath  in 


PRACTICE    OF   OSTEOPATHY.  413 

both  gynecology  and  obstetrics,  for  example,  he  stimulates  the 
sacral  nerves  to  contract  the  uterus  and  lessen  hemorrhage,  or 
he  stimulates  the  upper  lumbar  to  gain  dilatation  of  the  os.  By 
treatment  to  the  lumbar  and  sacral  regions  he  regulates  the 
blood-supply  through  the  vaso-motor  innervation  described 
above. 

Inhibition  of  the  clitoris  is  held  to  relax  the  circular  fibres 
of  the  cervix  and  dilate  the  os.  Inhibition  at  the  4th  sacral 
nerve  is  used  to  relax  the  vagina. 

The  TREATMENT  of  female  disorders  is  eminently  successful. 
It  will  be  seen  from  the  above  description  of  lesions  and  of  ana- 
tomical relations  that  osteopathy  can  gain  control  of  the  motor, 
vaso-motor,  and  nervous  mechanisms  of  the  liver.  A  knowl- 
edge of  these,  and  proper  treatment  of  them  in  a  given  case  are 
all  that  is  necessary.  A  study  of  the  facts  above  in  regard  to 
nerve-supply,  lesion,  and  case  reports,  will  enable  one  to  work 
out  proper  treatment  for  a  given  condition. 

In  any  case  the  removal  of  lesion  as  soon  as  possible  is  of 
the  utmost  importance.  Frequently  this  is  the  only  treatment 
necessary.  Quite  generally,  the  removal  of  lesion,  together 
with  a  little  spinal  and  abdominal  treatment  are  found  to  be 
sufficient  for  complicated  cases. 

In  any  painful  case  one  must  first  make  thorough  spinal 
inhibition  from  the  ninth  dorsal  to  and  including  the  sacral 
nerves.  In  this  way  all  the  sensory  nerves  noted  above  are 
reached.  Often  this  preliminary  treatment  is  used  to  great  ad- 
vantage in  allaying  the  local  pain  to  such  an  extent  as  to  allow 
of  local  or  abdominal  treatment  which  before  could  not  be  en- 
dured. 

The  osteopathic  method  of  examination  and  treatment  of 
the  uterus  and  vagina  locally  has  been  described  in  Part  I. 

In  cases  of  suppression  of  menses  the  treatment  must  look  to 
the  removal  of  the  lesion  obstructing  the  circulation.  This 
must  be  expected  particularly  along  the  region  described  above 
as  the  location  of  the  vaso-motors  for  ovaries,  uterus,  etc.,  i.  e.r 
along  the  5th  to  12th  dorsal,  all  the  lumbar,  and  all  the  sacral 
region.  Examination  must  also  be  made  for  pressure  of  an  ab- 
dominal organ,  such  as  the  transverse  colon,  upon  the  ovarian 


414  PRACTICE    OF    OSTEOPATHY. 

artery.  In  any  case  it  is  well  to  work  carefully  down  along  the 
course  of  this  vessel,  beginning  a  little  above  the  level  of  the 
umbilicus  and  proceeding  downward  to  the  pelvis.  Usually  in 
these  cases  it  is  sufficient  to  give  a  thorough,  strong,  stimulating 
spinal  treatment,  from  the  9th  dorsal  down  to  the  sacrum.  It  is 
not  advisable  to  include  the  sacral  nerves  in  this  treatment,  as 
their  stimulation  contracts  the  uterus  and  closes  the  os.  It  is 
better  to  relax  the  tissues  over  them  and  to  inhibit  them. 

During  the  spinal  stimulation  all  spinal  parts  and  tissues 
should  be  carefully  relaxed  and  sprung.  This  treatment  in- 
cludes stimulation  of  the  llth  and  12th  dorsal  and  1st  and  2nd 
lumbar,  by  way  of  which  effect  is  gotten  upon  the  connections 
of  the  inferior  mesenteric  ganglion,  stimulation  of  which  aids  in 
dilating  the  os.  One  may  also  treat  this  ganglion  directly  by 
deep  abdominal  treatment  over  its  site,  it  lying  upon  the  inferior 
mesenteric  artery  a  little  below  and  externally  from  the  umbilicus. 
Further  treatment  may  be  made  down  over  the  course  of  the 
common  and  internal  iliac  vessels,  stimulating  their  flow.  The 
clitoris  should  be  inhibited,  and  the  uterus  should  be  replaced  if 
prolapsed.  Inhibition  may  be  made  upon  the  pudic  nerve  where 
it  crosses  the  spine  of  the  ischium.  Sometimes  dilatation  of  the 
cervix  and  os  uteri  aid  the  case.  The  same  treatment  applies 
to  scant  menses. 

In  many  of  these  cases  the  general  health  suffered  severely. 
Particularly  is  one  apt  to  find  the  lungs  involved  in  cases  of  any 
length  of  standing.  Careful  attention  must  be  given  the  lungs 
and  the  general  health. 

Irregular  menstruation  is  generally  corrected  by  such  a 
co'urse  of  treatment. 

In  DYSMENORRHCEA  the  first  step  is  to  apply  the  strong 
spinal  inhibition  along  the  area  of  sensory  innervation  described 
above.  Careful  and  moderately  strong  inhibition  applied  at 
successive  points  from  the  middle  dorsal  down,  given  in  such 
a  way  that  the  spine  is  sprung  and  held  at  each  point  for  two  or 
three  minutes,  has  the  effect  of  relaxing  the  spinal  tissues,  re- 
lieving the  irritation  and  gently  starting  the  flow.  Commonly 
a  little  trying  will  indicate  a  certain  point  in  the  spine  at  which 


PRACTICE    OF    OSTEOPATHY.  415 

inhibition  gives  immediate  relief.  This  point  is  different  in  the 
different  cases. 

Dysmenorrhoea  is  generally  relieved  by  a  treatment  which 
gently  starts  the  menstrual  flow.  Quite  commonly  these  cases 
are  due  to  retarded  circulation.  Hence  one  must  do  gentle  ab- 
dominal manipulation  over  the  vessels  and  tissues  concerned. 
It  is  also  often  advisable  to  give  a  light  spinal  stimulation,  as 
above,  with  this  purpose  in  view. 

A  common  cause  of  dysmenorrhoea  is  sudden  stoppage  of 
the  flow  by  malposition  of  the  uterus,  leading  to  congestive  ob- 
struction of  the  circulation.  In  such  cases  it  is  necessary  to 
carefully  replace  the  uterus.  Local  treatment  must,  however, 
be  avoided  at  time  of  menstruation  except  in  cases  of  the  most 
urgent  necessity.  Often  the  treatment  given,  as  described,  gives 
instant  relief. 

It  is  sometimes  necessary  to  give  a  general  spinal  treatment 
to  quiet  the  nervous  system,  as  nervous  disturbances  may  cause 
dysmenorrhoea.  In  cases  due  to  cold  a  thorough  general  treat- 
ment, including  stimulation  of  heart  and  lungs,  may  be  added 
to  the  treatment  outlined  above.  In  these  cases  a  hot  tub  bath 
or  hot  vaginal  douches  may  be  the  only  aid  required. 

In  menorrlwa,  metrorrhagia  and  uterine  hemorrhages  often 
there  is  a  specific  lesion  of  the  innominate  present.  The  innom- 
inates  should  be  adjusted,  at  the  symphysis  pubes  as  well  as  at 
the  articulation  with  the  sacrum.  A  special  treatment 
recommended  in  these  cases  is  to  place  the  knee  against  the 
sacrum  and  pull  backward  upon  both  innominates.  Obviously 
one  must  have  in  view  the  removal  of  the  cause,  whatever  it  is, 
and  the  stanching  of  the  hemorrhages  by  the  contraction  of  the 
blood-vessels. 

Often  a  quick,  rather  hard  jerk,  at  the  hairy  covering  of  the 
mons  veneris  is  sufficient  to  contract  the  vessels  and  stanch  the 
flow.  Quick  and  rather  forcible  stimulation  of  the  round  lig- 
aments where  they  cross  the  pubic  arch,  about  an  inch  each  side 
of  the  symphysis.  will  help.  Stimulation  of  the  clitoris  and 
strong  stimulation  of  the  sacral  nerves  contract  the  uterus,  cervix, 
and  os,  and  are  important  means  of  stopping  the  flow.  One 
should  avoid  stimulation  of  the  lower  dorsal  and  lumbar  regions 


416  PRACTICE    OF    OSTEOPATHY. 

of  the  spine.  In  some  cases  compression  of  the  common  and  in- 
ternal iliac  arteries  is  helpful.  Deep  pressure  is  to  be  made  upon 
them  and  continued  for  considerable  time.  In  some  cases  good 
results  have  been  gotten  in  this  way. 

Injections  of  very  hot  or  of  cold  water  are  often  useful. 

The  patient  should  be  on  her  back  with  the  hips  elevated. 
This  quiets  the  heart  and  aids  the  venous  drainage. 

Vicarious  Menstruation  yields  to  the  treatment  directed  to 
re-establishing  the  normal  menstrual  function.  It  should  at 
the  time  be  treated  as  any  hemorrhage,  according  to  the  place 
at  which  it  appears. 

Prolapsus  Uteri  and  the  various  displacements  are  consid- 
ered in  Part  I.  In  case  of  adhesions  with  prolapsus,  it  is  the  aim 
to  gradually  stretch  and  break  them  down  by  carefully  stretch- 
ing the  organ  away  from  them.  This  may  be  generally  accom- 
plished. It  is  done  by  local  treatment.  It  is  probable  that  this 
process  is  in  part  an  absorption  of  the  adhesive  tissues  by  the 
renewed  circulation,  as  in  case  of  fibroid  tumors,  etc. 

To  strengthen  the  ligaments  to  hold  the  organ  in  place, 
treatment  must  look  to  the  removal  of  lesion,  the  spinal  and  ab- 
dominal stimulation  of  the  blood-supply,  and  the  strengthening 
of  the  perineum.  Stimulation  of  the  pudic  nerve  at  the  spine  of 
ischium  aids  the  latter  object.  In  young  girls  stimulation  of  the 
round  ligaments  and  external  abdominal  treatment  to  the  iliac 
blood-supply,  etc.,  is  usually  quite  sufficient  for  a  cure. 

In  cases  of  Leucorrhoea  the  object  is  to  correct  circulation 
and  prevent  the  abnormal  secretions.  The  condition  is  usually 
due  to  obstruction  of  the  vaginal  circulation,  and  quite  often 
occurs  along  the  lower  lumbar  or  sacral  region.  Its  removal 
usually  soon  results  in  cure.  Often  the  local  circulation  is  im- 
peded by  a  prolapsed  uterus,  resulting  in  leucorrhcea.  In  such 
cases  cure  of  the  prolapsus  is  necessary.  Lumbar  and  sacral 
stimulation,  and  abdominal  treatment  about  the  deep  pelvic 
vessels  aid  in  correcting  the  circulation.  Cleanliness  is  essential. 
Hot  vaginal  douches  are  useful. 

In  Congestive  Disturbances  of  the  Ovary  and  Ovaritis,  correc- 
tion of  the  circulation  is  the  main  object.  The  abdomen  is  apt 
to  be  quite  painful  in  the  region  of  the  ovaries,  and  it  is  necessary 


PRACTICE    OF    OSTEOPATHY.  417 

first,  often,  to  make  spinal  inhibition  along  the  course  of  the  sen- 
sory nerves.  After  this  careful  abdominal  treatment  may  be 
given,  relaxing  all  the  local  abdominal  tissues  and  thus  freeing 
the  local  circulation.  The  work  should  be  carried  up  along  the 
course  of  the  ovarian  vein,  which  accompanies  the  ovarian  artery 
above  described.  A  certain  amount  of  spinal  stimulation  is 
useful  in  the  correction  of  circulation. 

The  treatment  for  the  fallopian  tubes  is  local  and  spinal  of 
the  kind  described. 

In  all  cases  of  pelvic  disorders  it  is  well  to  see  that  the  lower 
ribs  are  well  raised,  and  that  no  obstruction  to  circulation  from 
the  lower  abdomen  occurs  at  the  diaphragm.     The  treatments 
given  to  raise  the  abdominal'  and  pelvic  viscera  are  also  helpful. 
(Chap.  VIII). 

For  the  treatment  of  ovarian  and  uterine  tumors  see  "Tu- 
mors. ' ' 

For  the  Climacteric  treatment  is  largely  symptomatic,  to 
relieve  the  headache,  hot  flashes,  nervous  disturbances,  etc.  A 
constitutional  treatment  is  given,  with  special  attention  devoted 
to  the  spinal  system,  to  strengthen  the  nervous  system  and  to 
quiet  nervousness.  Local  treatment  to  the  uterus  is  not  nec- 
essary unless  local  trouble  exists.  Care  should  be  taken  not  to 
bring  on  the  menstrual  flow  by  hard  treatment  in  the  lumbar 
and  sacral  regions. 

In  Phlegmasia  Alba  Dolens  (Milk-leg)  the  treatment  con- 
sists in  the  removal  of  lesion  and  the  correction  of  circulation 
to  the  limb.  The  adjustment  of  innominate  lesion,  or  of  a  lux- 
ation of  the  hip-joint,  and  the  relaxation  of  the  pelvic  muscles 
may  be  all  the  treatment  necessary.  These  causes  act  as  ob- 
structions to  the  nerve  and  blood-supply  and  cause  the  trouble. 
The  thigh  should  be  flexed  and  rotated,  and  treatment  may  be 
given  as  for  varicose  veins,  q.  v.,  to  aid  in  the  venous  return 
from  the  limb. 

OBSTETRICS. 

It  is  not  the  object  here  to  deal  with  the  conduct  of  a  case 
of  child-birth.  That  is  left  to  special  works  upon  the  subject. 
It  is  sufficient,  within  the  scope  of  this  \vork,  to  give  the  special 


418  PRACTICE    OP    OSTEOPATHY. 

osteopathic  points  in  connection  with  obstetrical  work. 

It  is  the  common  practice,  during  the  early  stage  of  labor, 
after  the  true  pains  have  commenced,  to  hasten  labor,  if  desir- 
able, by  stimulation  at  the  parturition  center  at  the  2nd  lum- 
bar. This  increases  circular  contractions  in  the  uterus,  causes 
descent  of  the  cervix,  and  dilatation  of  the  os.  It  is  usually  best 
to  rely  upon  the  natural  process  of  labor  and  very  often  this 
treatment  is  not  used. 

Later  one  may  aid  the  further  dilatation  of  the  os  by  inhi- 
bition of  the  clitoris.  This  is  accomplished  by  pressure  over 
the  lower  part  of  the  pubic  symphysis,  between  the  labia.  In- 
hibition of  the  round  ligaments  is  also  used  for  this  purpose. 

For  severe  pains  in  the  back,  desensitize  about  the  5th  lum- 
bar and  relax  the  neighboring  spinal  tissues. 

If  the  bearing  down  pains  do  not  come  regularly  and  hard 
enough,  one  should  give  occasional  firm  stimulation  in  the  re- 
gion of  the  second  lumbar. 

As  the  head  is  descending  the  finger  should  be  used  to  press 
back  the  edges  of  the  os  all  around  the  head.  Also,  in  case  of 
folds  in  the  vaginal  walls,  they  should  be  kept  smoothed  out, 
and  the  walls  should  be  pressed  well  up  and  outward  all  around. 
If  these  folds  occur  they  cause  great  pain  an-i  headache. 

To  prevent  laceration  of  the  perineum,  both  hands  should 
be  applied  to  the  pelvis.  One  presses  the  tissues  down  over  the 
pubic  arch  and  inhibits  the  clitoris,  while  the  other  grasps  the 
two  tubers  ischii  and  springs  them  toward  each  other,  at  the 
same  time  supporting  the  perineum.  As  the  head  is  born  the 
hand  makes  pressure  against  it,  as  required,  to  prevent  its  coming 
with  too  great  force. 

When  the  afterbirth  is  ready  for  delivering,  slight  stimula- 
tion at  the  upper  lumbar  will  aid  it  if  necessary.  If  necessary, 
a  quick  pull  at  the  mons  veneris  will  aid  in  expelling  it.  A 
cough  will  sometimes  be  sufficient  to  start  it. 

After  it  is  born  the  hand  should  be  placed  upon  the  abdom- 
inal wall  and  support  the  uterus  until  it  is  well  contracted  and 
hard. 

Desensitize  the  clitoris  to  stop  after  pains. 


PRACTICE    OF    OSTEOPATHY.  419 

It  is  well  to  flex  and  circumduct  the  limbs  carefully,  be- 
fore leaving  a  case,  to  see  that  there  are  no  slips  at  the  hip- joints 
or  excessive  contractures  of  muscles,  which  may  lead  to  milk-leg. 


DISEASES   OF  THE   MALE   GENERATIVE   ORGAXS. 

CASES:  (1)  Orchitis,  in  a  young  man,  following  muscular 
strain.  Lesions:  4th  lumbar  posterior,  5th  lumbar  anterior, 
left  iliac  very  painful.  The  left  testacle  was  affected.  The 
treatment  at  once  gave  relief.  The  lesion  was  corrected  and  the 
case  was  cured. 

(2)  Orchitis  due  to  lesion  at  the  10th  and  llth  dorsal  ver- 
tebrae.    The  patient   was  in  intense  pain   and  the  testacle  was 
greatly  swollen.     Relief  was  immediate,  and  cure  as  well,  upon 
removal  of  lesion. 

(3)  Edematous  swelling  of  the  prepuce  in  a  boy.  following 
accident  in  which  the  innominate  bone  was  luxated.     Its  cor- 
rection cured  the  case. 

(4)  Impotence;  lack  of  power  to  secure  erection  in  a  man 
suffering  from  marked  contracture  and  soreness  of  the  lumbar 
muscles,  due  to  being  on  the  feet  too  much.     One  treatment  re- 
laxed the  muscles  and  overcame  the  difficulty. 

(5)  Impotence  and  splenitis.     Lesions:  Oth.  10th,  and  llth 
left    ribs    depressed;    posterior    curvature    in    the    dorso-lumbar 
region,  prostate  gland  atrophied.     The  case  was  cured  in  four 
months. 

(6)  Impotence  in  a  man  of  fifty-one,  of  three  to  four  months 
standing.     Lesions:  4th   and   5th   lumbar   turned   to   the   right. 
1st  lumbar  to  the  left.  4th  dorsal  vertebra  to  the  right.     The 
patient  had  tried  medicine,  electricity,  and  hydrotherapy  with- 
out avail.     He  was  cured  by  six  weeks  treatment. 

(7)  Varicocele  in  a  case  which  had  tried  medical  treatment 
without  success,  and  in  which  operation  was  recommended.     It 
was  entirely  cured  by  osteopathy  in  five  weeks. 

(8)  Enlarged    prostate   gland    in    a    man    of    seventy-eight, 
causing  retention  of  urine  and  cystitis,  for  which  he  had  been 
unsuccessfully  treated  for  many  years.     Treatment  reduced  the 
gland,  and  the  case  entirely  recovered. 


420  PRACTICE    OF   OSTEOPATHY. 

(9)  Enlarged   prostate   in   a   man   of   sixty-eight,    who   for 
several  months  had  suffered  with  some  retention  of  the  urine. 
The  prostate  was  reduced  by  a  few  treatments  and  the  case  was 
cured. 

(10)  Prostatitis  and  stricture  of  the  urethra  in  a  man  of 
forty.     He  had  had  an  operation  for  the  stricture,  but  it  wras 
unsuccessful.     There  was  great  pain  upon  urination,  and  Avrnk- 
ened  sexual  power.     The  case  was  entirely  cured  in  two  months. 

(11)  Gonorrheal    prostatitis    in    a    young    man.     Operation 
had  been  unsuccessful.     The  prostate  was  enlarged  and  hard. 
It  was  reduced  by  treatment  and  the  case  was  cured. 

LESIONS  AND  ANATOMICAL  RELATIONS  in  diseases  in  the 
male  generative  organs  occur  in  positions  corresponding  to  le- 
sions pointed  out  in  female  pelvic  diseases.  These  lesions  occur 
from  the  8th  or  9th  dorsal  down,  including  the  lumbar,  lumbo- 
sacral,  and  innominate  lesion.  The  lower  lesions  seem  to  be  the 
more  important  ones. 

It  is  to  be  noted  that  vaso-motors  for  both  external  and 
internal  genitals  occur  in  the  male  in  the  same  regions  as  de- 
scribed in  female  diseases,  at  the  2nd,  3rd,  4th  and  5th  lumbar 
and  at  the  sacral  nerves.  The  sympathetics  convey  to  the 
prostate  sensory  fibres  derived  from  the  10th,  llth,  (12th)  dor- 
sal; 1st,  2nd,  3rd  sacral,  and  5th  lumbar;  and  to  the  prostate 
from  the  10th  dorsal.  (Quain).  For  the  epididymis  sensory 
fibres  are  derived  from  the  llth  and  12th  dorsal  and  1st  lumbar. 

It  is  readily  seen  that  the  lesions  usually  found  in  male  gen- 
erative diseases  fall  within  these  areas  of  innervation. 

TREATMENT:  In  all  these  cases  it  is  necessary  to  bear  in 
mind  the  anatomical  relations  of  lesion  to  disease,  and  to  see  that 
such  lesion  is  removed.  In  a  good  many  of  these  conditions  the 
removal  of  lesion  is  all  that  is  required.  After  removal  of  the 
irritating  cause,  spinal  and  abdominal  treatment  of  the  kind 
described  for  female  diseases  is  usually  helpful. 

The  treatment  for  the  prostate  has  been  described  in  Part  I. 
In  cases  of  prostatitis  the  treatment  must  be  carefully  applied 
locally,  and  it  should  be  directed  particularly  to  freeing  the  tis- 
sues about  the  gland.  Great  case  is  necessary  not  to  irritate 
the  structure.  Abdominal  and  spinal  treatment  may  be  added. 


PRACTICE    OF    OSTEOPATHY.  421 

For  Orchitis  the  treatment  is  mainly  in  removal  of  lesion. 
This  immediately  relieves  and  usually  cures  the  case.  Spinal 
and  abdominal  treatment  may  be  directed  to  the  relaxation  of 
tissues,  relief  of  tension,  and  correction  of  circulation.  The 
tissues  about  the  inguinal  canal  should  be  kepi  relaxed  to  main- 
tain free  drainage  from  the  testacle.  Treatment  should  be  carried 
well  up  along  the  spermatic  vein,  terminating  on  the  left  in  the 
renal  vein  and  on  the  right  in  the  inferior  vena  cava  at  about 
the  same  level.  The  abdominal  viscera  may  be  raised  to  aid 
free  circulation.  The  patient  should  remain  quiet.  If  the  case 
is  severe  he  may  lie  upon  his  ba-ck  with  hips  elevated.  The 
irritating  pressure  of  clothing,  etc..  should  be  avoided. 

In  case  of  Varieoeele  the  object  of  the  treatment  is  to  empty 
the  over-distended  veins,  to  strengthen  the  vessels,  and  to  re- 
move the  causes  which  obstruct  the  circulation.  Lesion  in  the 
lower  lumbar  and  sacral  region  is  usually  present  and  weakens 
the  vaso-nv.)tor  innervation  of  the  parts.  Allowing  of  sluggish 
circulation  and  venous  engorgement.  The  lesion  must  be  re- 
moved, and  spinal  treatment  is  made  to  strengthen  the  v  a  so- 
motor  supply.  The  veins  are  stripped  to  empty  them,  and  the 
manipulation  is  carried  up  over  the  spermatic  vein  to  its  con- 
nection with  the  renal  vein.  Care  must  be  taken  to  see  that  the 
tissues  about  the  inguinal  canal  do  not  obstruct  the  veins,  also 
that  pressure  from  the  abdominal  viscera  i>  entirely  removed. 
To  this  end  the  bowels  must  be  kept  free  and  the  abdominal 
contents  should  be  raised  as  before  directed. 

In  some  cases  surgical  interference  may  be  necessary,  yet 
on  the  other  hand  cases  have  been  saved  from  operation  by  the 
treatment. 

Impotence  and  Spermatorrhoea  have  been  very  successfully 
treated.  In  some  cases  thorough  relaxation  and  stimulation 
of  the  spinal  musculature  and  nerves  from  the  middle  dorsal 
region  down  is  the  only  treatment  necessary.  In  other  cases 
the  removal  of  innominate  lesion  and  the  stimulation  of  the 
sacral  nerves  has  been  successful.  It  is  well  to  have  the  patient 
lie  on  the  side  and  then  strong  pressure  is  made  with  the  knee 
in  the  sacro-iliac  articulations,  springing  them  freely. 

In  these  cases  lesion  at  the  region  of  the  genito-spinal  center 


422  PRACTICE    OF   OSTEOPATHY. 

in  the  cord  (1st  and  2nd  lumbar)  is  sometimes  present  and  re- 
sponsible for  the  trouble. 

A  good  point  of  treatment  is  to  stimulate  the  perineal  nerve 
where  it  crosses  the  spine  of  the  ischium.  •  This  strengthens  the 
erector  muscle  of  the  penis.  Enlargement  of  the  prostate  gland 
is  sometimes  closely  associated  with  these  conditions,  and  it 
should  be  reduced  according  to  directions  given  above. 

All  causes  of  reflex  irritation,  as  from  an  elongated  prepuce, 
constipation,  nervousness,  etc.,  must  be  removed.  It  is  quite 
necessary  in  most  cases  to  direct  general  treatment  to  the  quiet- 
ing and  strengthening  of  the  nervous  system.  In  these  nervous 
cases  it  is  well  to  place  the  patient  upon  a  simple  diet,  with  the 
avoidance  of  stimulants  and  excitement.  Cold  baths,  exercise, 
and  outdoor  life  are  helpful. 

GONORRHCEA  AND  SYPHILIS. 

Some  cases  of  syphilis  and  a  number  of  cases  of  gonorrhoea 
have  been  treated  osteopathically.  Some  success  has  been  ap- 
parent in  the  treatment  of  syphilis,  the  patient  at  the  time  being 
considerably  bettered  or  gaining,  entire  relief  from  the  symptoms 
with  which  he  was  suffering.  Extended  observation  of  these 
cases,  however,  has  not  as  yet  become  a  matter  of  record. 

Gonorrhrea  is  usually  readily  cured  without  the  usual  se- 
quelse.  The  special  treatment  is  to  the  blood-supply  upon  the 
lines  laid  down,  with  the  idea  of  controlling  the  circulation  and 
reducing  the  inflammation.  Constitutional  treatment  is  given, 
and  liver,  kidneys,  and  bowels  are  kept  active  to  aid  in  getting 
rid  of  the  poisons. 

TUMORS. 

CASES:  (1)  Ovarian  tumor,  upon  which  operation  was 
advised,  cured  by  two  months  treatment. 

•(2)  Uterine  fibroid  tumor,  the  patient  having  for  sixteen 
years  suffered  intensely  at  period.  Surgeons  were  about  to 
operate  upon  the  case,  when  it  was  decided  to  try  osteopathy. 
After  four  treatments  the  period  was  passed  without  any  dis- 
comfort. After  three  months  treatment  the  tumor  had  disap- 
peared. 


PRACTICE    OF    OSTEOPATHY.  423 

(3)  Intestinal  fibroid  tumor.     There  was  a  history  of  con- 
stipation, and  colicky  pains  for  a  number  of  weeks,  constantly 
increasing  in  severity  and  frequency,  and  leading  finally  to  spasms. 

The  abdomen  was  much  distended  with  feces  and  gas;  the 
10th,  llth  and  12th  ribs  were  displaced  downward.  The  tumor 
could  be  deeply  palpated  in  the  left  side  of  the  abdomen,  at  the 
level  of  the  crest  of  the  ilium. 

The  colon  was  cleared  with  repeated  enemas  of  water  and 
oil.  As  the  tumor  still  remained  an  operation  was  decided  upon. 
But,  before  the  day  set.  the  tumor  loosened  under  osteopathic 
treatment,  and  was  passed  from  the  rectum.  It  was  in  size 
lH  by  1]4  inches.  It  was  examined  by  leading  physicians  who 
pronounced  it  fibroid  tumor. 

(4)  A  tumor  upon  the  back  of  the  neck,  due  to  a  much  en- 
larged sebaceous  gland,  had  been  growing  for  ten  years.     Treat- 
ment was  directed  to  softening  the  contents  of  the  gland  until 
able  to  pass  it  through  the  duct,  the  passage  being  facilitated  "by 
removal  of  the  hair  into  the  follicle  of  which  the  gland  emptied. 
Under  the  treatment  the  tumor  had  been  much  reduced  at  the 
time  of  report. 

(5)  A  tumor  of  the  brain,  so-called,  was  a  condition  found 
to  be  due  to  a  displacement  of  the  atlas  and  a  great  contraction 
of   the   cervical   muscles.     The  head  was  drawn   backward,   the 
giddiness,  insomnia,  and  ocular  disturbances  were  present.     The 
condition  seemed  likely  to  lead  to  insanity,  and  leading  physicians 
diagnosed  it  as  a  tumor  upon  the  brain.     Correction  of  the  le- 
sion  cured   the  case,   and   the  diagnosis  of  cerebral  tumor  was 
shown  to  be  wrong. 

(6)  An  abdominal  tumor  in  a  lady,  the  waist  measuring  46^ 
inches,  and  increasing  at   the  rate  of  one  inch  per  week.     Le- 
sion was  found  at  the  oth  dorsal,  also    at  the  llth,  and  the   left 
ribs  were  luxated.     The  tumor  appeared  to  be  as  large  as  a  cocoa- 
nut.     At  the  end  of  one  months  treatment  the  growth  had  been 
stopped  and  the  waist   measurement   was  reduced  one  inch;  at 
the  end  of  2  months,  the  waist  was  31 ]  ^  inches,  and  had  reached 
nearly    normal  size.     The    treatment   Avas    continued   for   three 
months  longer,  and  the  case  was  discharged  cured. 

(7)  A  tumor  of  the  breat.  about  the  size  of  a  walnut,  very 


424  PRACTICE    OF    OSTEOPATHY. 

hard  and  involving  the  center  and  deep  portion  of  the  gland. 
Sharp  pains  radiated  in  all  directions  from  the  tumor,  but  mostly 
toward  the  axillary  region. 

The  condition  was  found  to  be  an  engorgement  due  to  ob- 
structed vessels,  with  which  the  gland  is  richly  supplied.  The 
lesion  was  a  twist  of  a  clavicle,  narrowing  the  space  between  the 
clavicle  and  first  rib,  and  caused  by  using  a  crutch  for  a  lame  leg 
upon  the  same  side  as  the  lesion.  Thus  was  caused  an  obstruc- 
tion to  the  lymphatic  drainage  of  the  breast,  and  the  growth 
resulted.  As  a  preliminary  measure  the  limb  was  cured  and  the 
use  of  the  crutch  was  dispensed  with.  The  clavicle  was  righted 
and  the  growth  began  to  be  absorbed.  The  case  was  cured  in 
seven  weeks. 

(8)  A  tumor  just  external  to  the  vaginal  orifice,   of  four 
months  standing.     There  was  a  fluid  contained  in  the  tumor, 
and  it  varied  in  size,  becoming  smaller  after  the  patient  had  re- 
mained in  a  recumbent  position  for  a  few  days.     There  was  pro- 
lapsus of  the  uterus  and  lesion   among  the  lumbar  vertebrae. 
The  case  was  cured  in  two  months. 

(9)  An  ovarian  tumor  in  a  patient,  from  whom,  two  years 
previously,   the  left  ovary   and   a  tumor  weighing  twenty-five 
pounds  had  been  removed.     A  few  months  later  a  tumor  ap- 
peared upon  the  right  ovary,  and  operation  was  advised.     After 
a  month  and  a  half  of  treatment  the  tumor  had  disappeared. 

(10)  Fibroid  tumors  of  the  uterus  in  a  patient  who  had, 
four  years  previously,  been  injured  in  the  left  side  by  a  vicious 
cow.     The  patient  was  suffering  from  heart  and  bowel  troubles, 
and  female  diseases.     Various  spinal  lesions  were  found.     By 
four  treatments  the  tumors  were  loosened  and  passed,  there  being 
several  of  them,  varying  in  size  from  that  of  a  hen's  egg  to  that 
of  a  walnut. 

The  PROGNOSIS,  generally  speaking,  to  benefit  or  cure  various 
tumors  by  osteopathic  treatment  is  good.  Numerous  cases  have 
been  saved  by  this  means  from  the  surgeon's  knife.  While  many 
tumors  cannot  be  cured,  the  treatment  merits  a  trial  in  every 
case  before  operation  be  submitted  to. 

The  LESIONS  are  various  bony,  muscular,  and  other  ob- 
structions to  blood  and  lymph  flow,  or  to  nerve-supply.  Some 


PRACTICE    OF    OSTEOPATHY.  425 

lesions  cause  tumorous  growths  by  direct  irritation  of  the  tis- 
sues. A  frequent  cfause  of  tumors  is  found  in  lesion  to  the  lym- 
phatic drainage  of  a  part,  through  direct  pressure  upon  its  lym- 
phatic vessels  or  by  constrictor  effect  upon  them  by  lesion  to 
the  vaso-motor  and  sympathetic  nerve-supply.  Tumors  of  the 
breast  are  very  often  due  to  such  a  cause. 

The  common  lesions  in  tumor  of  the  breast  are  found  at  the 
clavicle,  first  rib,  among  the  upper  five  or  six  ribs,  or  among  the 
corresponding  vertebrae.  Abdominal  tumors  are  commonly 
caused  by  lower  rib  and  lower  vertebral  lesions,  uterine  tumors 
by  sacral  or  lumbar  lesions,  etc. 

The  simple  TREATMENT  is  to  remove  lesion,  correct  lym- 
phatic and  blood  drainage,  or  remove  any  source  of  direct  irri- 
tation upon  the  tissues.  Correcting  anatomical  relation  is  the 
main  point,  and  commonly  no  manipulation  directly  upon  the 
tumor  is  required,  yet  such  a  measure  is  sometimes  employed  to 
soften  a  fatty  tumor  and  aid  in  its  absorption,  or  to  loosen  a 
fibroid  growth,  several  such  having  thus  been  loosened  and  dis- 
charged per  rectum  or  per  vaginam.  One  instance  is  recorded 
in  which  external  treatment  upon  the  nose  loosened  and  caused 
the  discharge  of  a  cancer  in  the  upper  nasal  passage. 

It  is  a  point  worthy  of  note  that  in  many  instances  fibroids, 
according  to  all  evidences,  have  been  absorbed  by  the  renewed 
blood-currents.  It  indicates  that  new  fibrous  tissues,  once 
formed,  mav  be  absorbed  under  the  treatment. 


426  PRACTICE    OF    OSTEOPATHY. 


Index. 


PAGE 

Abdominal  aorta  ......................................  52 

Abdomen,  general  treatment  of  ..........................  53 

Abdomen,  osteopathic  points  of  ..........................  52 

Abscess,  of  kidneys  ....................................  222 

of  liver  .........................................  197 

Acidity  of  stomach  ....................................  143 

Acute  yellow  atrophy  of  liver  ...........................  199 

Acute  nasal  catarrh  ....................................  105 

Adhesions,  uterine  ..................................     66,  416 

Alba  dolens  ..........................................  417 

Albuminuria  ..........................................  223; 

Alcoholism  ...........................................  395 

Alveolar  emphysema  ...................................  1  03 

Amyloid  degeneration  of  kidney  .........................  214 

degeneration  of  liver  .............................  119 

Angina  pectoris  .......................................  251 

Aneurysm  ............................................  263 

cerebral  ...........................  .  ............  311 

Ankle,  dislocation  of  ...................................  72 

Ankylosis,  bony  and  ligamentous  ....................     406,  407 

Apoplexy  ..............................................  308 

Appendicitis  ..........................................  167 

Arrythmia  ............................................  249 

Arterio-sclerosis  .....................................  .  .  262 

Articulation,  tempero-maxillary  .........................  27 

Ascaris  lumbricoides  ...................................  393 

Ascending  paralysis,  acute  ..............................  311 

Ascites  ...............................................  183 

Anemia  ..............................................  349 

Arthritis  deformans  ...................................  359 

Asthma  ..............................................  75 

Ataxia,  locomotor  ........................  j  ............  280 

Ataxic  paraplegia  ...................................... 


PRACTICE    OF   OSTEOPATHY.  427 

Atlas  examination  of 23 

treatment  of 2& 

Atony  of  stomach 143 

Autumnal  catarrh  (See  Hay  Fever) 85 

Axis 24 

B 

Bell's  paralysis -. 300 

Bladder,  inflammation  of 22."> 

Bleeding  from  nose 36 

Blood  disease 345 

Bloody  flux 392 

Brachycardia 249 

Brachial  plexus 25 

Bright's  disease,  acute 210 

chronic 212 

Bronchiectasis 84 

Bronchitis 80 

Bony  ankylosis 406 

''  Breaking  up"  treatment 311 

Bulbar  paralysis 16 

C 

C'alculi,  renal 219 

Cancer  of  liver 119 

Cancer  of  stomach 144 

Cardia,  spasm  of 1 42 

Cartilages,  palpation  of 21 

Carpo-metacarpal  dislocations 6& 

( 'ataract 

C'atarrh,  nasal 105 

Catarrh,  ear 35 

Catarrh,  autumnal 85 

Catarrhal  croup 371 

Catarrhal  Enteritis 158 

fever,  epidemic 375 

pneumonia 97 

Cerebro-spinal  fever 391 

Cephalodynia 27<> 

Cerebro-spinal  meningitis 391 


428  PRACTICE   OF    OSTEOPATHY. 

Cerebral  hemorrhage 308 

aneurysms 263 

apoplexy 308 

Cervical  vertebra 23 

Cerumen  of  ear 33 

Children,  diarrhreas  of 160 

Chickenpox , 388 

Cigarette  habit 395 

Cholera  morbus 161 

infantum 161 

Cholangitis 195 

Chorea 267 

Circulatory  system 230 

Cirrhosis  of  the  liver 189 

atrophic 190 

billiary 190 

malarial 191 

hypertrophic 7 191 

Clitoris,  inhibition  of 413 

Clavicle  treatment  of .">  1 

Climacteric 417 

Coccyx,  treatment  of 18 

Coccygodnia 320 

Colds 105 

Colic 1 59 

Colitis  mucous 161 

simple  ulcerative 157 

Colon 149 

Comparison  of  limbs 60 

Comparison  of  size  of  thorax 38 

Congestion  of  kidney 215 

Constipation 145 

Congestion  of  liver 188 

lungs 97 

ovaries 416 

Contractures  of  spinal  muscles 10 

Conjunctiva 31 

Consumption,  pulmonary 93 


PRACTICE  OF  OSTEOPATHY.  429 

Constitutional  diseases 353 

Convulsions,  infantile 213 

ursemic 224 

Crepitus  of  vertebra 24 

Cricoid  cartilage 21 

Croup 371 

Croupous  enteritis 158 

Curvatures  of  spine 8 

Cystitis 225 

D 

Deafness 34,  342 

Deformities 40,  398 

Delirium  tremens 396 

Deviation  of  spine 8 

Deformities  of  sternum 40 

Diabetes  mellitus  and  diabetes  insipudus 365 

Discharges  from  ear 35 

nose 105 

Diarrhoea 150 

of  children 160 

nervous 150 

Diphtheria 370 

Displacements  of  spine 9 

Diseases,  infectious 370 

Disease,  Pott's 402 

Dilatation  of  stomach 142 

of  heart 261 

Dislocations  of  ankle 72 

carpo-metacarpal 68 

carpal 68 

of  elbow 67 

of  hip 73 

of  knee 72 

metacarpal-phalangeal 68 

phalangeal 68 

radio-ulnar 68 

of  shoulder 69 

of  vertebra 16 


430  PRACTICE    OF   OSTEOPATHY. 

of  wrist 68 

Duodenal  ulcer 155 

Dyspepsia 142 

Dysentery 392 

Dysmenorrhoea 414 

E 

Ear, -discharges  from 35 

drum  of 33 

cerumen  of 33 

examination  of 33 

itching  and  tenderness 33 

Ear  diseases 339-44 

Edema  of  lungs 98 

Elbow,  dislocations  of 67 

Emphysema 103 

Endocarditis 252 

Enteritis 150 

Entorrhagia 156 

Enterospasm 161 

Enteroptosis 175 

Enuresis 227 

Epilepsy 271 

Epistaxis 110 

Esophagus,  spasm  of 132 

stricture  of 132 

Esophagitis 131 

Equilibrium  of  spine 20 

Erysipelas 385 

Eustachian  tubes 33 

Exaggeration  of  lesions 13 

Examination,  general 8 

of  atlas 23 

of  innominates 58 

of  larynx 21 

of  limbs 67 

of  neck 19 

of  plevis 36 

of  rectum . .  63 


PRACTICE    OF    OSTEOPATHY.  431 

Examination  of  spine 7 

of  thorax 38 

of  trachea 

of  vagina 64 

Exhaustion,  heart 397 

Exudative  nephritis 212 

Eye,  treatment 31 

foreign  bodies  in 31 

diseases  of 328 

F 

Fallopian  Tubes 412 

Fatty  degeneration  of  heart 255 

of  kidney 214 

of  liver 198 

Female  disorders 407 

Fever,  cerebro-spinal 391 

epidemic  catarrhal 375 

scarlet 389 

spotted 391 

thermic 397 

typhoid 380 

Fifth  lumbar  vertebra,  treatment  of 17 

Fifth  nerve,  branches 32 

treatment  of 32 

Flatfoot 320 

Flux,  Bloody 392 

Folicular  ulcer 156 

Foreign  bodies  in  nose 36 

in  eye 31 

French  measles 388 

G 

Gallstones 191 

( lastralgia 138 

Gastritis,  acute 133 

chronic 133 

Gastroptosis 1 44 

Generative  organs,  male 418 

Genitalia.  vaso-motors  of. .  412 


432  PRACTICE   OF    OSTEOPATHY. 

German  measles 388 

Glands,  thyroid 21 

cervical  lymphatic 21 

Gout « 360 

Gonorrheal  arthritis 358 

Glossitis 118 

Gluteal  arteries 62 

Gonorrhoea 422 

Granulation  of  Eye 32 

Growths  of  nose 36 

Gynecology 407,  413 

H 

Hardening  of  Spinal  Muscles 10 

Hay  fever 85 

Head...' 

palpation  of 28 

position  of 20 

rotation  of 22 

temperature 22 

Head  mirror,  use  of 33 

Hearing,  impaired 34 

test  for 34 

Heart,  diseases  of 230 

Heat  stroke 397 

Hematurea 

Hematozoon  of  Leveran 393 

Hemorrhage,  cerebral 309 

intestinal 156 

of  lungs .' 100 

of  spinal  cord 310 

of  stomach 144 

uterine 415 

Hemorrhagic  infarct 100 

Hemothorax 114 

Hip,  dislocation  of 73 

Hydrocephalus 311 

Hydroperitoneum 183 

Hvdrothorax . .  114 


PRACTICE    OF    OSTEOPATHY.  433 

Hyoid  bone 20 

treatment  of 28 

muscles,  treatment  of 21 

Hyperacidity  of  stomach 143 

Hypertrophy  of  liver 198 

Hypertrophy  of  heart 260 

Hypogastric  plexus 63 

I 

Iliac  blood  vessels 63 

Impotence 421 

Infantile  convulsions 313 

paralysis 309 

Infectious  diseases 370 

Influenza 375 

Innominate  bone,  treatment 58 

Insanity 323 

Insomnia 293 

Insolation 397 

Inspection  of  spine 7 

of  tonsils 20 

Interstitial  nephritis 212 

Intestinal  neuroses 157 

obstruction 171 

parasites 393 

tumors 166 

ulcer 156 

Intussuseption 

Intoxications,  The ,  395 

J 

Jaundice 185 

Joint  affections 398 

K 

Kidney,  abscess  of 222 

amyloid 214 

congestion  of 215 

fatty  degeneration  of 214 

movable 222 

Knee-chest  position 54 

28 


434  PRACTICE    OF   OSTEOPATHY. 

Knee,  dislocation  of 72 

L 

Lagrippe 375 

Laryngeal  tenderness 21 

diphtheria •. 371 

Laryngitis 116 

Lateral  deviation  of  spine 8 

Ligaments,  lesions  of 10 

tenderness  of 60 

Ligamentous  ankylosis 406 

Lateral  structures  of  neck 23 

treatment 28 

Leg,  milk 417 

Leveran,  Hematozoon  of 393 

Leucorrhoea . 416 

Limbs,  comparison  of  length 60 

Lightning  stroke 398 

Lithemia 223 

Liver,  abscess  of , 197 

acute  yellow  atrophy  of 199 

amyloid,  infiltration  of 199 

cancer  of 199 

cirrhosis  of 189 

fatty  degeneration 198 

hypertrophy  of 198 

sclerosis  of 189 

Locomotor  ataxia 280 

Longitudinal  traction  of  spine 13 

Lumbricoides,  ascaris 393 

Lungs,  congestion  of 97 

Lumbago 358 

Lungs,  edema  of 98 

hemorrhage  from 100 

tuberculosis  of 93 

Luxations  of  ribs,  treatment 47 

of  sternum 40 

M 

Male  generative  organs 419 


PRACTICE    OF   OSTEOPATHY.  435 

Malaria 378 

Manipulation  of  coccyx 18 

of  hyoid  bone 28 

of  spine 12 

Maxillary,  inferior,  in  whooping  cough 375 

Mastodynia 320 

Measles,  French,  German 386-378 

Metacarpal  phalangeal  dislocations 68 

Menses — irregular,  suppressed 413-414 

Men,  diseases  of 418 

Meningitis,  cerebro-spinal 391 

Menstrual  disorders 411-414 

Menstruation  vicarious 416 

Middle  cervical  ganglion 26 

Migraine 276 

Milk  leg 417 

Motor  neuroses 160 

Mucus  enteritis 158 

Mumps ' 127 

Morphine  habit 395 

Muscles,  diseases  of 316 

stretching  of 15 

of  spine 10 

Myotonia  congenita 316 

Myocarditis 250 

Myxedema 352 

N 

Neck  anterior 19 

lateral  structure  of 23 

palpation  of : 20 

posterior  structures  of 23 

posterior  aspect  of 19 

treatment  of 28 

thickening  of  tissues 25 

Nephritis  acute 210 

chronic 212 

Nephroptosis 222 

Nephrolithiasis 21 


436  PRACTICE   OF   OSTEOPATHY. 

Nerves,  auricular 25 

brachial 25 

fifth 32 

laryngeal 21 

middle  cervical 26 

occipital 25 

phreni  c '2'2 

pneumogastric 21 

recurrent  laryngeal 21 

superior  laryngeal 21 

superior  cervical  ganglion 25 

Nervous  dyspepsia 142 

Neuralgia 316 

Neurasthenia 289 

Neuritis  localized 322 

brachial 322 

multiple 323 

Neuroses,  intestinal 157 

motor 160 

occupation 285 

secretory 158 

sensory 159 

Nose,  bleeding  from 36 

examination  of 35 

foreign  bodies  in 36 

growths  in 36 

secretions 35 

treatment 36 

O 

Occupation  Neuroses •. 285 

Obesity 362 

Obstetrics 407,  413, 418 

Opium  Habit 395 

Orchitis 421 

Ovaries 411,416 

Ovaritis 416 

Osteopathic  points  of  abdomen 52 

head . .  7 


PRACTICE    OF    OSTEOPATHY.  437 

Osteopathic  work  per  rectum t>:>> 

vagina 04 

Oxyuris  vermicularis :'>'.):•> 

P 

Paralysis 297 

ascending 311 

agitans 284 

Imlbar 311 

infantile 312 

penman's 280 

of  cartilages 21 

neck 20 

spine 8 

Parasites 393 

Pancreatitis,  acute 201 

chronic 127 

Paratitis 8 

Patient,  general  examination  of 

Pelvic  plexus 03 

Pelvis,  examination  of 55 

Peritonitis 178 

Perforation  of  ear  drum 33 

Perineum 07 

Pert  ussis 373 

Phrenic  nerve 22 

Phlegmasia  alba  dolens 417 

Pharyngitis :  .  .  .  228 

Phalangeal  dislocation 08 

Pianist's  paralysis 280 

Pin  worms 393 

Pleurisy Ill 

Pneumonia 93 

Pneumo  thorax 114 

Points  of  spinal  weakness ~ .  10 

Position  of  waist  line 01 

of  head - 20 

Posterior  iliac  spine GO 

Pott's  disease . .  402 


438  PRACTICE    OF    OSTEOPATHY. 

Posterior  structure  of  neck 23 

aspect  of  neck .- 19 

Prolapsus  uteri 416 

Ptyalism 121 

Pubic  symphysis,  tenderness  of 60 

Pudic  nerve 62 

artery 62 

Pulmonary  hemorrhage 100 

tuberculosis 93 

Pulsation  of  abdominal  aorta 52 

Pyelitis 221 

Pyelonephritis 221 

Pyonephrosis 221 

Q 

Quadratus  lumborum  muscles,  to  stretch 49 

Quinsy .  / 126 

B 

Radial  ulnar  dislocations 68 

Rectum,  examination  of 63 

treatment  of 64 

Reduction  of  dislocations 68 

Still's  method 16 

Relaxed  spine 10 

Relaxing  ligaments 15 

Relief  of  tension 12 

Renal  calculi 219 

dropsy 229 

Ribs,  abnormalities  of 38 

treatment  of 43 

Rickets 364 

Rigid  spine 10 

Rheumatism 354 

Rubella 388 

Rubeola 386 

S 

Sacrum,  treatment  of  luxations 18 

Salivary  glands • 121 

Scaleni  muscles 25 


PRACTICE  OF  OSTEOPATHY.  439 

Scarlet  fever 389 

Sclerosis  of  liver 189 

Sciatica 321 

Separation  of  spinal  processes 9 

Seat  worms 393 

Secretory  neuroses 158 

Secretions  of  nose 35 

Sensory  disorders 143 

Skull.' 37 

Smallpox 390 

Sore  throat 128 

Spiral  treatment  of 30 

Solar  plexus . . 55 

Spermatic  vessels 63 

Spermatorrhoea 421 

Spastic  paraplegia 280 

Spasmodic  croup 371 

Spinal  curvatures 402 

Splenitis 199 

"Spine,  typhoid 381 

Stomach  disease 137 

Stomach  supersecretions 143 

Stomach  ulcer  of 144 

cancer  of 144 

Strains 406 

St.  Vitus'  dance 267 

St.  Anthony's  Fire 385 

Sternum,  deformities  of 40 

Sternum,  luxations  of 40 

treatment 50 

Stroke,  lightning 398 

heat 398 

Stomatitis 118 

Sub-acidity 143 

Sunstroke 397 

Strabismus,  treatment  of 30 

Spine,  rotation  of 14 

Syringomyelia 31 


440  PRACTICE    OF    OSTEOPATHY. 

Superior  laryngeal  nerves 21 

Superior  cervical  ganglion 25 

Superior  laryngeal 21 

Suppressed  menses . . . '. 413 

Spinal  cord  hemorrhage 310 

Sounds  of  spine 11 

Stercoreal  ulcer 156 

Suppurative  cholangitis 197 

Strangulation  of  bowel 171 

Syphilis 422 

T 

Trenia  latum 393 

saginata 393 

sodium „ 393 

Tape  worm - 393 

Temperature  of  spine 9 

Thermic  fever 397 

Treatment  of  spine 11-18 

Temperature  of  head 22 

Tests  for  hearing 34 

Tenderness  of  symphises 60 

Thread  worms 393 

Treatment  of  axis ' ~ 29 

of  neck 28 

of  spine ' 30 

of  clavicle 50 

of  coracoid 21 

of  thorax 43 

of  abdomen 53 

of  eye 31 

of  rectum 64 

Thorax,  temperature  of 39 

examination  of 38 

comparison  of  sides 39 

Tonsils,  treatment  of 21 

Tuberculosis  of  lungs „• 93 

Tonsillitis 123 

Treatment  of  vagina 66 


PRACTICE    OF   OSTEOPATHY.  441 

Tubes,  fallopian 407-412 

Tumors 422 

Typhoid  fever 380 

spine 381 

U 

Uvula 37 

Ulcer  of  stomach 144 

follicular 156 

Urinary  diseases 203 

Uremia 223 

Uterus 66 

Uterus,  adhesions  of 416 

hemorrhage  of 415 

motors  of : 412 

prolapsus  of 416 

sympathetic  supply  of 412 

vaso-motors  of 412 

V 

Vagina,  adhesions 66 

examination 64 

treatment 66 

relaxation  of 413 

vaso-motors  of 412 

Valvular  heart  disease 258 

Varicose  veins 265 

Varicella 388 

Variola 390 

Varicocele 421 

Vaso-motors  of  genitalia 412 

Vertebra,  reduction  of 16 

fifth  lumbar,  treatment 17 

cervical,  deviation  of 23 

crepitus  of 24 

Vicarious  menstruation 416 

W 

Women,  diseases  of 407-64 

Worms 393 

pin 393 


442  PRACTICE    OF    OSTEOPATHY. 

Worms,  round 393 

seat 393 

thread 393 

tape 393 

Wrist,  dislocation  of 68 

Whooping  cough 373 

X 

Xerostoma 121 


PRINTED  IN   U.».».  CAT.     NO.     24      161 


J£.SOUT, 


000  556  897 


